Delirium

This page contains sections about delirium and resources at Island Health.

  1. Delirium in the older person
  2. Delirium in the older person - A Family Guide
  3. Delirium in the older person - A Medical Emergency
  4. Useful Links
  5. Resources
  6. Professional Practice Resources

1. Delirium in the older person

Delirium is a sudden, fluctuating change in mental state, which disturbs thinking and attention, and results in changed behaviour.

If delirium is not recognized, it can lead to permanent disability or death.

This information is for anyone who supports an elder who develops a delirium – family members and health care professionals alike.

Island Health has produced two educational DVDs:

A Medical Emergency

Delirium is a change in mental state which comes on suddenly, fluctuates over 24 hours, alters consciousness, disturbs thinking and attention and results in changed behaviour. Symptoms include problems with attention, thinking, memory, psychomotor changes and disruption of the sleep-wake cycle (Lipowski, 1989; Ignatavicious, 1999; Bater, 2006; DSM-5, 2013). 

Delirium is considered a “medical emergency”

Delirium affects older persons in all areas of health care. All staff must be skillful in recognizing and responding to it.

The statistics are shocking. Despite the fact that Delirium is treatable,

In Acute Care:

  • 50% of older persons may develop delirium in hospital

  • 40-50% of older persons develop delirium after hip surgery

  • 70% of person 65+ admitted to intensive care (National Guidelines, 2014)

In Residential Care:

  • 22-89% of residents with dementia experience delirium (National Guidelines, 2014)

2. Delirium in the Older Person: A Family Guide 

Winner of a 2007 Gold Questar International Award for Video Communication.

This DVD is for families affected by delirium, to help them learn more about what it is and how to cope with it.

The 27-minute video follows the experience of two families when a loved one develops delirium. It includes information and advice from health care professionals and medical experts. A family's ability to recognize delirium can be of life-saving importance. Getting prompt assessment and treatment for the underlying cause can mean the difference between returning to normal life or being confined to increasing levels of care, or even death.

Order:


3. Delirium in the Older Person: A Medical Emergency

Winner of the 2006 International Medical Media Award for Geriatrics (The Freddies) 

This DVD contains a 30-minute overview of expert information about delirium in the older person, and specific care information for:

  • acute care (18 minutes)
  • home and community care (23 minutes) 
  • residential care (19 minutes) 
  • delirium at end of life (4 minutes)

Use:

  • as a teaching tool to improve ability to recognize, assess and intervene with delirium
  • for formal education of staff, families and clients 
  • to learn about Delirium Watch and Elder Friendly programs in acute care
  • for case conferencing and discussion groups
  • as self-directed learning, at your convenience and at your own pace
  • conjunction with resources from this website

Order:


4. Useful Links

Canadian Coalition of Seniors Mental Health

Tools for Seniors and Families, and for Clinicians, including the National Guidelines for Assessment and Treatment of Delirium and more. https://ccsmh.ca/projects/delirium/  

RN Association of Ontario

Nursing Best Practice Guideline and Caregiving Strategies for Older Adults with Delirium, Dementia and Depression. 
RNAO - Nursing Best Practices

HealthLink BC

Talk to a nurse by phone, or contact them for algorithms for delirium. In British Columbia, dial 8-1-1.
http://www.healthlinkbc.ca/ 

Acute Care Geriatric Nurse Network 

Delirium Clinical Practice Guidelines; links and resources from BC's Clinical Nurse Specialists in geriatrics, gerontology, geropsychiatry, and geriatric rehabilitation.
http://www.acgnn.ca/delirium.html 

Institute for Health Care Improvement

http://www.ihi.org/topics/SedationDeliriumMobility/Pages/default.aspx

Delirium in ICU

http://www.icudelirium.org/
http://www.medpagetoday.com/CriticalCare/GeneralCriticalCare/42029

National Institute for Health Care Excellence

http://pathways.nice.org.uk/pathways/delirium#path=view%3A/pathways/delirium/delirium-overview.xml&content=view-index
http://www.nice.org.uk/guidance/QS63/chapter/introduction


5. Resources

Information about delirium for families and health care professionals, including tools, flow sheets, learning tools and professional practice information.

About Delirium 

Delirium in the Older Person. Overview of delirium; tools for recognition, assessment and treatment of delirium are placed in context. This is a useful teaching handout. Bibliography.

Quick Reference Tools

Delirium Decision Tree 
Quick Reference Guide 

Prevention

Island Health Delirium Clinical Standards Guidelines [Please contact us]
Drugs that can Cause Delirium 
You Can Prevent Delirium Poster 

Recognition

Information Pamphlet for Families 
Information Pamphlet for Health Care Providers
2 Ds Differentiating Delirium from Dementia
3 Ds Differentiating Delirium from Dementia and Depression
Physiological Changes with Aging
Age-Related Changes

Assessment

Confusion Assessment Method (CAM)
CAM Training Manual  
CAM-ICU
CAM-ICU Training manual
Laboratory Investigations
Behaviour Monitoring Chart
Sleep-Wake Monitoring Chart 
Sleep Hygiene Log
Symptom Screening
Search for Cause (legal-size)

Intervention

Search for Solutions (legal-size)
Hallucinations and Delusions

Learning about Delirium: Take a Quiz

Age-Related Changes (read before playing game below)
Jeopardy!
Delirium Crossword
2D Quiz Delirium, Dementia or Depression? - answer key included
3D Quiz Delirium, Dementia or Depression? - answer key included
Pre and Post Learning Test - answer key included


6. Professional Practice Resources:

Acute Care

The Assessment and Treatment of Delirium - Canadian Coalition for Seniors’ Mental Health 2014 Guideline Update
Delirium Watch - Alert

For additional tools used within Island Health, see Seniors Health or contact us.

Delirium at End of Life

End of Life Care National Health Service, U.K.


Disclaimer:

The documents available on this Delirium website are designed as a general reference for dealing with delirium in the older person.

The information contained herein was written for use within Island Health and we make no warranty, expressed or implied. While care has been taken to ensure accuracy of the information, it is not intended to provide medical advice or to replace the specific recommendations of physicians and other health team members. Since Best Practice and Standards of Care are constantly evolving, it is advised that this site not be used as the sole source of information. You are encouraged to also consult other current references.

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