© Copyright 2019 Grief Probate Journey Blog *THIS INFORMATION HAS BEEN SOURCED FROM UK AND AMERICAN WEBSITES AND OUR OWN EXPERIENCES*
The following information has been put together through Google searching and our own experience. Please see Delirium which covers the following areas:
- Introduction to our experience with Delirium
- Treatment/Cures for Delirium
- Infection and Delirium
- Dementia Vs Delirium
- Hospital Delirium
- Types of Delirium
- Delirium in the Elderly
- Useful Links
1. Introduction to our experience with Delirium:
Because of the various infections our Dad contracted as a result of the Infective Endocarditis infection, he would often get delirium. We had never heard of this term until it happened to our Dad. What a learning curve this alone was. It would be very scary for us as in the beginning when delirium first occurred, despite asking, we were never forewarned of when an episode had started. As an example, we would leave him in the evening, return in the morning and he would be in delirium however we’d had no prior warning from hospital staff.
As this was all new to us, we had to ask for help and advice numerous times from hospital staff in the hope we could try and:
- Have a better idea of what to expect
- How to help and support our Dad when he was going through it.
The research combined with knowing our Dad meant that fortunately, I became able to recognise when delirium was starting and when it was going away. I recognised this better than some of the hospital staff. I am not a medical professional, yet I could recognise the signs within less than five minutes. Sadly, upon Our Dads readmission to the hospital in January 2017, delirium was occurring much more frequently (He was discharged to home in December 2016 for a very short while).
Our Dads medical condition was quite complex, this meant there were many different medical teams involved in his care. It was a real struggle for us as a family to understand everything, whilst trying to do the very best we could.
We had minimal support to better understand the condition and had to research and learn it for ourselves. The following is what we have learnt from this situation:
2.1 “Delirium, also known as acute confusional state, is an organically caused decline from a previous baseline level of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in attention, consciousness, and cognition”.
2.2 “Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. The start of delirium is usually rapid — within hours or a few days”.
“Signs and symptoms of delirium include a decrease in attention span, intermittent confusion, disorientation, cognitive changes, hallucinations, altered level of consciousness, delusions, dysphasia, tremors, dysarthria, and a decrease in short-term memory”.
- “Clouding of consciousness”.
- “Difficulty maintaining or shifting attention”.
- “Fluctuating levels of consciousness”.
“Experts have identified three types of delirium: Hyperactive delirium. Probably the most easily recognized type, this may include restlessness (for example, pacing), agitation, rapid mood changes or hallucinations, and refusal to cooperate with care. Hypoactive delirium. (27 Jun 2018)”.
Whenever our Dad was in delirium it was upsetting times. It was extremely difficult to deal with, and also very hard to witness. This condition would take over our Dad and make him act in a completely different way. It is only because we truly knew our Dad that we knew it was the delirium causing these behaviours, it was nothing at all to do with his character.
However, even though we knew this, it was still very difficult especially on occasions when the following occurred:
- Paranoid – It would make him feel as though his family were against him. This always made us feel very sad.
- Rude/Abrupt – He would be very rude to us. We knew this was not our Dad as he was so polite and considerate in nature.
- Aggressive – This was extremely scary, witnessing our Dads actions, knowing fully well if he was aware of what he was doing it would upset him. (He would do things like try to pull out any drips or tubes that might have been attached)
- Refuse treatment – blood tests, blood sugar checks etc. These times were so difficult, we would try our very best to convince him these things needed to be done, but in times of delirium, everything became difficult. In the extreme bad times I would have to remind myself, do not take this to heart, it is not our Dads fault. It is delirium, this is when we would try our very best to do anything and everything in our power that we could in order to help him fight the delirium away.
“Sometimes delirium makes a person abnormally alert, restless or agitated, and possibly even aggressive. This is known as ‘hyperactive’ delirium. … Someone can have both delirium and dementia. It can sometimes be difficult to tell what is causing a person’s symptoms”
“The three subtypes of delirium are hyperactive, hypoactive, and mixed. Patients with the hyperactive subtype may be agitated, disoriented, and delusional, and may experience hallucinations. … Delirium in these patients may go unrecognized or be confused with depression or dementia.1 Mar 2003″.
This often occurred for our Dad.
- Hallucinate – This would cause him too: Believe he was being attacked by missiles and things like that. See things in the room that weren’t there. (He lost his sight due to the Infective Endocarditis Infection going into his eyes).
Again this was very hard to see, and when we would try to convince him there was no one there, or no one trying to attack him, it would agitate him. This is where we would have to gage situations every time he went into delirium and act in the best way accordingly to try and make the delirium pass faster.
- “Speak clearly and use fewer words.”
- “Don’t argue with or correct them”.
- “Comfort them”.
- “Make sure they’re wearing their aids (like their glasses, hearing aids, or dentures)”
- “Keep the area around them calm and soothing”.
Whenever possible, I would do video calls, so my sister and nephews could see and talk to our Dad, but of course, for my sister, it was never the same as actually being there herself. This would often get her down, which made me feel sad for her. Unfortunately, due to circumstances, we just had to adjust and do our best.
Our mum would go to the hospital whenever she could, however certain of our Dads infections also meant it wasn’t advisable for her to visit. And on top of that her mobility meant it wasn’t always easy for her. However, despite all of this, we made joint efforts to ensure there was a constant family presence for our Dad.
Sadly, despite all our best efforts collectively with:
- Family both in England and overseas
- Friends support (visiting our Dad.
- His family abroad talking on the phone, Leaving uplifting voice notes).
Our best efforts did not pay off. We thought that if our Dad had regular contact with not only our immediate family but his own too it would help to boost and motivate him on the road to recovery. There was only so much that we could do non medically to motivate and uplift our Dad’s spirits.
3. Treatment and cures for Delirium:
“The most common medications used are antipsychotic medications. While this is a common and seemingly useful strategy, the literature is still mixed. A 2015 meta-analysis of 15 studies found that second-generation antipsychotics (SGAs) may treat delirium better than placebo, usual care, or haloperidol.21 Mar 2018″.
“Delirium gets better when the cause is treated. You can recover very quickly, but it can take several days or weeks. People with dementia can take a particularly long time to get over delirium”.
“If the cause of delirium is identified and corrected quickly, delirium can usually be cured. Because delirium is a temporary condition, determining how many people have it is difficult. Delirium affects 15 to 50% of hospitalised people aged 70 or older”.
“Elderly Hospital Patients with Delirium More Likely to Die Within A Year. Older patients with delirium are at increased risk of death within the year following diagnosis, according to a new study. Delirium in elderly patients is frequently overlooked or misdiagnosed as depression, dementia or severe illness.8 Nov 2011″.
“Sometimes, a person who is dying may become restless, anxious or confused. This confusion and disorientation is also called delirium. Delirium has many possible causes, including drugs, disease, brain metastases, changes in metabolism and infections. Delirium can develop quickly over a number of hours or days”.
“Complications of delirium may include the following: Malnutrition, fluid and electrolyte abnormalities. Aspiration pneumonia. Pressure ulcers. Weakness, decreased mobility, and decreased function. (25 Apr 2019)”.
4. Infection And Delirium:
“After delirium. The symptoms of delirium usually get better over a few days to weeks. However, delirium usually means a person will have to stay longer in hospital. It can have lasting consequences after the condition has been treated too”.
“Delirium can be triggered by a serious medical illness such as an infection, certain medications, and other causes, such as drug withdrawal or intoxication. Older patients, over 65 years, are at highest risk for developing delirium. Some patients become agitated, while others may be quietly confused. (6 Dec 2018)”
5. Dementia Vs Delirium:
“The differences between dementia and delirium. Dementia develops over time, with a slow progression of cognitive decline. Delirium may be the first and perhaps only clue of medical illness or adverse medication reaction in an individual with Alzheimer’s. Often, persons with dementia develop delirium while hospitalised”.
“Older people who have experienced episodes of delirium are significantly more likely to develop dementia, according to new research. However, the new research shows that episodes of delirium can have long term effects – increasing the future risk of dementia eight-fold.10 Aug 2012″.
“Delirium and dementia are separate disorders but are sometimes difficult to distinguish. In both, cognition is disordered; however, the following helps distinguish them: Delirium affects mainly attention. Dementia affects mainly memory”.
6. Hospital Delirium:
“We cannot say it is due to any one factor.” The short-term effects of delirium can differ from patient to patient. In the long term, delirium can cause permanent damage to cognitive ability and is associated with an increase in long-term care admissions”.
“In the long term, delirium can cause permanent damage to cognitive ability and is associated with an increase in long-term care admissions. It also leads to complications, such as pneumonia or blood clots that weaken patients and increase the chances that they will die within a year. “Delirium is an emergency”.
“Hospital-induced delirium hits hard. It’s not an ideal place for recognizing, let alone treating, delirium.” The condition, a temporary but severe form of mental impairment that can lead to longer hospital stays and negative long-term outcomes, is commonly acquired by elderly patients in acute care settings”.
- “Consult with a geriatric specialist”.
- “Bring a full medication list to any new health professional. Many drugs that act on the brain can cause delirium, including narcotic painkillers, sedatives (particularly benzodiazepines), stimulants, sleeping pills, antidepressants, Parkinson’s disease medications, and antipsychotics”.
- “Make things familiar”.
- “Stay close”.
- “Insist on sensory aids”.
- “Promote activity”.
- “Be there for meals”.
- “Participate in discharge planning”.
More items…1 May 2018
Hospital staff would often ask us what things is your Dad familiar with, as this will help bring him comfort which could help bring him out of delirium faster. What we would often have to repeat is that the situation we are in now is almost like having a new Dad in the sense that:
- He entered this hospital with sight
- He entered this hospital being able to walk
- He entered this hospital an independent man who had looked after himself his whole life
We told them, in such a short space of time, he’s had a complete lifestyle change. And as he has lost his sight and is now bedbound, that really makes it hard for us, as everything our Dad loved and enjoyed to do is no longer possible. However, knowing our Dad and his strength of character, and love for his family whenever possible I would do:
- Video calls to my sister and nephews so that he could hear their voices
- Asked his friends to come and visit
- Asked our family members to visit
- Asked his family abroad in Canada and Barbados, as well as our family and friends too:
- Do an encouraging uplifting voice note – Whenever my Dad was feeling low, i.e. too tired to try and do physio or if we were trying to fight the delirium I would play the voice notes for him
- Family abroad would phone him via Whatsapp. Although he had lost his sight, seeing the joy on his face when these things happened was truly priceless
Because our Dad had various infections which led to him being barrier protected my sister couldn’t visit as she would like to as she had the two young children and so it wasn’t advised.
These circumstances meant I was at the hospital every day throughout the whole seven months, taking notes, questioning whatever I didn’t understand, speaking up about things that we the family were not pleased about. (My mum and sister would also raise their own concerns when they visited).
Despite our Dad’s terrible ordeal, he still managed to remain positive. I remember one day in the hospital randomly Dad said, this is the reverse (or something along those lines). I asked him what he meant, and he said. “I’ve had my sight all my life and was able to walk all my life. I could have been born this way” I couldn’t believe what my ears were hearing and cannot explain how that made me feel. In all this the man that our Dad was, he was able to find such a positive outlook on his situation.
I think I said something back like, wow Dad, that’s brilliant and amazing that you can still think so positively. At any opportunity we had, we would give our Dad all the encouragement that was possible. To try and uplift him spiritually and mentally. We would often tell hospital staff his mental state of mind counts as well. This is what will contribute to him giving up. We would say this in regards to keeping him active with physio, being taught to use knife and fork etc so he could feed himself in the moments outside of delirium.
As a family within the remit of what we were told by hospital staff, and what we researched ourselves, we did most of the above. We were highly involved in our Dad’s care, sadly this would mean quite frequently we were met with resistance. We did not allow this to deter us. Our Dad’s care was far more important than how some of the hospital staff would make us feel.
7. Types of Delirium:
- “Hyperactive delirium. Probably the most easily recognized type, this may include restlessness (for example, pacing), agitation, rapid mood changes or hallucinations, and refusal to cooperate with care”.
- “Hypoactive delirium”.
- “Mixed delirium”.
“It is usually the brain’s reaction to an underlying medical problem. This could be an infection, such as a chest infection or a urinary tract infection. Delirium can also be caused by severe illness, surgery, pain, dehydration, constipation, poor nutrition or a change in medication”.
Our Dad suffered both Hypo and Hyper delirium. We would always dread whenever we saw the signs of it returning. Please see some visual examples below of types of Delirium:
8. Delirium in the Elderly:
“Sudden confusion can be caused by many different things. … Some of the most common causes of sudden confusion include: an infection – urinary tract infections (UTIs) are a common cause in elderly people or people with dementia. a stroke or TIA (“mini-stroke”)”
“Delirium is most often caused by physical or mental illness, and is usually temporary and reversible. … Delirium is common in the intensive care unit (ICU), especially in older adults. Causes include: Alcohol or medicine overdose or withdrawal. 22 Nov 2017″
9. Useful links:
- Delirium and Dementia – Confusion and Disorientation – Dementia UK
- Delirium – Alzheimer’s Society
- Hypoactive Delirium
- Sudden confusion (Delirium) – NHS
- Care & Treatment – Delirium Aging and Health
- Delirium in the Hospitalised Patient
- The Recognition and Diagnosis of Delirium Needs Improving
- How to Better Treat Delirium in Hospitals: A Q&A with expert Dr Valerie Page
- Elderly patients with Delirium more than likely to die within a year