Hailey Tran
Delirium is an altered state of consciousness that can develop over a short period of time, usually a few hours or days. It is often characterized by confusion, anxiety, and impaired thinking and remembering. Delirium is especially common in older adults, and those who are very sick or in the hospital. Treatment for delirium involves addressing the underlying causes, which can vary from infection to reaction to sedating drugs, oxygen deprivation, or organ failure. In a hospital setting, treatment can include removing unnecessary medical equipment from the patient's room, regulating sleep-wake cycles, providing reorientation techniques, and ensuring the presence of loved ones to help orient the patient to time and place.
| Characteristics | Values |
|---|---|
| Diagnosis | A quick diagnosis is important. Use a screening tool such as 4AT to identify delirium more accurately. |
| Examination | Conduct a thorough physical examination to check for pain or other health problems. |
| Tests | Order blood tests, x-rays, or other scans to identify the root cause. |
| Treatment | Address the underlying cause. There is no specific medicine or treatment. Use sleep or calming medications with caution as some sedatives can make delirium worse. |
| Support | Ensure the presence of loved ones to help orient the patient to time and place. The care team may remove unnecessary medical equipment from the room and maintain a calm and quiet environment. |
| Schedule | Establish a regular day and night schedule to help the patient maintain a normal sleep pattern. |
| Therapy | Encourage the patient to work with a physical therapist or occupational therapist. |
| Risk Factors | Age (70+), past delirium, memory/thinking problems, serious illness, dehydration, medication, use of a breathing machine. |
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What You'll Learn
Establish the underlying cause
Delirium is an altered state of consciousness, characterised by episodes of confusion and other symptoms. It is a syndrome, not a disease, and can occur at any age but is more common in elderly patients with compromised mental status. It is important to establish the underlying cause of delirium, as there is no specific medicine or treatment that can directly address it.
Delirium can be caused by a variety of health conditions, including infection, reaction to sedating drugs, oxygen deprivation, organ failure, alcohol toxicity, or alcohol withdrawal. Other factors that can put someone at risk include old age (70+), a past history of delirium, memory or thinking problems, serious illness, dehydration, vomiting or diarrhoea, impaired vision or hearing, taking multiple medications, or being on a ventilator. Delirium is also commonly associated with dementia, and can be a warning sign of its onset.
To establish the underlying cause, a thorough examination is required. This could include a physical examination to check for pain or other health problems, as well as further tests such as blood tests, x-rays, or other scans. A 4AT (4 A's test) can also be used to identify delirium more accurately. This involves a short set of simple questions that measure alertness, such as whether the person is drowsy or agitated.
Once the underlying cause or causes have been identified, they must be treated for the patient to recover from delirium. This may involve supportive therapy, pharmacological management, and addressing issues with fluid and nutrition intake.
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Treat the underlying cause
Delirium is a syndrome, not a disease, and is characterised by an altered state of consciousness, with episodes of confusion, anxiety, and impaired thinking and memory. It is often an indication of an underlying health problem, and the only way to treat delirium is to address the root cause.
Delirium can be caused by a variety of factors, including infection, reaction to medication, oxygen deprivation, organ failure, alcohol toxicity or withdrawal, vitamin B1 deficiency, dehydration, and more. It is also often a result of a combination of factors, which is why a thorough examination is necessary. For example, older people hospitalised for broken bones associated with falls may show signs of delirium after treatment. This can lead to a higher risk of developing dementia.
To treat delirium effectively, healthcare professionals must first diagnose it accurately. A 4AT (the 4 A's test) can be used to identify delirium accurately. This is a short set of simple questions that can be completed in around two minutes. Once delirium is confirmed, further tests can be carried out to identify the underlying cause, such as blood tests, x-rays, or other scans.
Treating the underlying cause of delirium is crucial, as it can help resolve the patient's delirium and prevent potential complications or long-term issues. In some cases, treating the underlying cause can lead to a quick improvement in delirium symptoms. However, for some patients, a full recovery may take longer, and they may still experience problems with memory and thinking even after the underlying cause has been addressed.
In addition to treating the underlying cause, it is also important to manage the patient's environment and daily routine. This includes regulating their sleep-wake cycles, providing a calm and quiet environment, and encouraging social interaction and engagement with family and friends.
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Manage sleep-wake cycles
Delirium is an altered state of consciousness, characterised by episodes of confusion and other symptoms, that can develop over hours or days. It is usually reversible, but it can last from a day to several months. Delirium is often a symptom of another health problem, and the only way to treat it effectively is to resolve the health problem that is causing it.
To help treat delirium, it is important to regulate sleep-wake cycles. This can be done by providing a darker, quieter environment at night to help the patient sleep, and a calm, well-lit environment during the day to help them stay awake. This can be achieved by closing the curtains and turning off the lights at night, and opening the curtains during the day to let in natural light. Reducing noise at night can also help to improve sleep quality.
It is also important to encourage patients to get out of bed and sit in a chair during the day, and to work with a physical therapist or occupational therapist if possible. This can help to regulate their sleep-wake cycle and improve their overall health.
In addition, the presence of loved ones can help orient a person with delirium to time and place, and having family and friends nearby can make the patient feel safer. A nursing assistant or other caregiver can also stay in the room with the patient to provide support and help them feel safe.
Finally, reorientation techniques or memory cues such as a calendar, clocks, and family photos can help the patient stay grounded in reality and improve their sense of time and place.
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Provide a calm environment
Providing a calm environment is a crucial aspect of treating delirium in a hospital setting. This involves creating a peaceful and stable atmosphere that promotes rest and recovery. Here are some strategies to achieve this:
Firstly, it is important to minimise noise and maintain a quiet environment, especially at night when patients need to sleep. This can be achieved by reducing noise levels, closing doors, and using earplugs if necessary. Additionally, during the day, natural light should be encouraged by opening curtains or blinds. A well-lit environment can help improve a patient's sense of orientation and reduce confusion.
The presence of a familiar person, such as a family member or friend, can also contribute to a calm environment. Loved ones can provide emotional support and help orient the patient to time and place. Their presence may help the patient feel safer and more grounded in their surroundings. However, it is important to ensure that visitors are well-informed about the patient's condition and any specific needs or triggers that should be avoided.
In some cases, it may be beneficial to remove unnecessary medical equipment from the patient's room. The presence of excessive equipment can be overwhelming and cause anxiety. By simplifying the environment and ensuring only necessary equipment is visible, the patient may feel more relaxed and comfortable.
Furthermore, maintaining a regular day and night schedule is essential. Helping patients establish a normal sleep pattern can improve their overall sense of calm and reduce agitation. This can be achieved by encouraging patients to stay awake during the day, exposing them to natural light, and promoting social interaction. At night, reducing noise, minimising light, and ensuring comfort can aid in a restful sleep.
Additionally, it is important to provide opportunities for physical activity and engagement during the day. Encouraging patients to get out of bed and sit in a chair, or even engage in gentle exercises, can improve their overall well-being and reduce restlessness. This can be supported by involving physical or occupational therapists as part of the patient's care team.
By implementing these strategies, healthcare professionals can create a calm and restorative environment that supports the treatment of delirium. Each patient's needs may vary, so adaptability and personalisation are key to ensuring the environment promotes a sense of peace and recovery.
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Ensure adequate nutrition
Nutrition is a key factor in delirium management. Fluids and nutrition should be administered carefully, as patients may be unwilling or physically unable to maintain a balanced intake. For example, patients suspected of having alcohol toxicity or withdrawal should be given multivitamins, especially thiamine (vitamin B1).
It is important to monitor the patient's nutritional intake and ensure they are receiving adequate nourishment. This may involve assisting them during mealtimes or providing nutritional supplements if their dietary intake is insufficient. Encouraging patients to eat a well-balanced diet can help improve their overall health and aid in their recovery.
Additionally, addressing any nutritional deficiencies can help reduce the risk of delirium. For instance, vitamin B1 (thiamine) deficiency has been linked to an increased risk of delirium. By ensuring patients receive adequate vitamin B1, either through their diet or supplements, healthcare professionals can help lower the chances of delirium occurring or worsening.
Maintaining proper nutrition is crucial for patients with delirium, as malnutrition can exacerbate their condition and prolong their recovery. Therefore, healthcare providers should closely monitor the patient's nutritional status and make adjustments as necessary to ensure their nutritional needs are being met.
Furthermore, adequate nutrition can help improve the overall brain health of patients with delirium. Certain nutrients, such as omega-3 fatty acids and antioxidants, are known to support brain function and cognitive health. Including these nutrients in the patient's diet or through supplements may help enhance their cognitive abilities and potentially improve their delirium symptoms.
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Frequently asked questions
Delirium is an altered state of consciousness, characterised by episodes of confusion, that can develop over hours or days. It is usually caused by other health problems, such as infection, reaction to sedating drugs, oxygen deprivation, or organ failure.
Treatment for delirium starts with addressing the underlying cause. A patient experiencing delirium may be given sleep or calming medications to help them rest, but some sedating drugs can make delirium worse. Steps to regulate sleep-and-wake cycles can also help. The patient's care team may also remove unnecessary medical equipment from their room to help them feel safer.
Family members can help orient a person with delirium to time and place. Having family and friends nearby can help a person with delirium feel safer. Reorientation techniques or memory cues such as a calendar, clocks, and family photos may be helpful.
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