Information for Patients, Relatives and Carers

Transcription

1 Delirium Department of Geriatric Medicine Information for Patients, Relatives and Carers This leaflet aims to describe the main symptoms of delirium and highlights those patients that are at high risk of developing it. This leaflet also looks at ways in which the risks of developing delirium can be reduced and interventions that can help manage and treat it. University Hospitals of Leicester NHS Trust

2 Contents Who this booklet is for and what it covers 2 What is delirium? 3 How common is delirium? 3 Why is it important to recognise delirium? 4 Who is at risk of developing delirium? 4 What causes delirium? 4 What are the signs and symptoms of delirium? 4-5 How long does delirium last? 5 Caring for patients with delirium what we can all do 6-9 Communicating with people with delirium on discharge from hospital 10 Notes for questions and contact numbers 11 Support for families and carers 12 ALL OUR STAFF WILL BE PLEASED TO HELP, IF YOU WOULD LIKE FURTHER ADVICE ON ANY OF THE TOPICS DESCRIBED IN THIS LEAFLET. UHL WELCOMES COMMENTS AND SUGGESTIONS FROM PATIENTS AND RELATIVES VIA SURVERY AND COMMENTS CARDS AND VERBALLY TO OUR STAFF. Who this booklet is for and what it covers This booklet is for people who have had delirium and their relatives and friends who care for them. It has been designed to help you understand how people with delirium should be treated and cared for. It will not answer all your questions but will help you to understand what delirium is, how it is recognised, diagnosed and treated and where to get more information and advice. 2

3 Who this booklet is for and what it covers (continued) If you have any questions about the information in this booklet or about you or your relatives treatment and care, please do not hesitate to ask the staff responsible for caring for you or your relative. What is delirium? Delirium is a condition which affects the brain for a short period of time and results in temporary or fluctuating state of confusion. People with delirium may appear confused or not with it when talking to them. It can cause restless behaviour, sleepiness and personality changes. Some patients see or hear things that are not there. Many patients do not remember much of the illness when they are better. They may not know where they are. How common is delirium? Delirium is a common problem which occurs in about out of every 100 people admitted to hospital Half of those undergoing surgery Quarter of care home residents It is the most common complication of hospitalisation in the older population. Delirium can also happen outside of hospital and is seen more commonly in those people who live in residential and nursing homes. 1 Meagher DJ; Delirium: optimising management. BMJ Jan 20;322(7279):

4 Why is it important to recognise delirium? At time it can be frightening for the person with delirium, as well as their carers and families and other patients. Patients with delirium have longer hospital stays and a higher frequency of complications, e.g. infections, falls and pressure sores. Many of them go on to need increasing help and support at home or may need to go into longer term care on discharge from hospital. Who is at risk of developing delirium? People who: are over the age of 65 have a current hip fracture are very unwell have dementia, or other memory problems What causes delirium? There are lots of causes of delirium which can make it a difficult condition to spot and deal with. The most common causes of delirium are medical conditions such as urine or chest infections, some medications, pain, constipation, dehydration and recent surgery. What are the signs and symptoms of delirium? Using the simple acronym below you can work out if the person is ACTS positive. If the person is ACTS POSITIVE then you need to ACT QUICKLY to deal with the possibility of delirium: 4

5 What are the signs and symptoms of delirium? (continued) Altered level of consciousness* or Attention Deficit ** Confusion - fluctuating Thinking (Disorganised) Sudden onset * The person may be lethargic or agitated **To test attention deficit ask patient to count from 20-1 backwards If you notice these symptoms in your relative or those you care for then let a healthcare professional know as soon as possible so delirium can be investigated, managed and treated as soon as possible. How is delirium treated? Treating delirium means treating the underlying cause. It is very important to figure out the cause of delirium as soon as possible. This usually means doing tests and asking questions. Once the cause is known, the most effective treatment can be given. This may include medication as well as changing the person s surroundings. How long does delirium last? It is difficult to determine how long the delirium will last but it can be days to months. Although acute confusion is a serious and worrisome condition, many older people do recover fully. The time they may take to recover varies. Patience and understanding is very important. Some older people do not recover fully from delirium. In these people, memory problems and personality changes may be permanent. Sometimes the episode of delirium brings to light a pre-existing mild dementia. 5

6 Caring for patients with delirium what we can all do The diagram and notes highlight what we can do for people with delirium whilst they are in hospital and what you can do to help during their hospital admission and when they return home. Is the person confused and disorientated? Is the person sleeping properly? Is the person in pain? Does the person have difficulty seeing/hearing? Is the person on lots of medication? Is the person eating and drinking properly? Is the person constipated/has urinary problems? Look for and treat infection Assess and optimise oxygen levels if necessary, as clinically appropriate Is the person unable to walk or has limited mobility? 6

7 What we can all do together Provide appropriate lighting and clear signage. A clock and a calendar should also be easily visible to the person at risk. Reorientate the person. Explain where and who they are, and what your role is. Encourage activities (reminiscence) that exercise the mind. Facilitate regular visits from family and friends and bring in familiar things from home such as pictures, books. Promote good sleep hygiene by avoiding procedures during sleeping hours and reducing noise to a minimum. Assess for pain. Look for nonverbal signs of pain, particularly in those with communication difficulties. Start and review appropriate pain management in any person in whom pain is identified or suspected. Resolve any reversible cause of the impairment, such as impacted earwax. Ensure working hearing and visual aids are available to and used by people who need them. For patients who take multiple medications a check on what medicines they are regularly taking will be carried out. Encourage the person to drink. Consider offering subcutaneous or intravenous fluids if necessary. Consider supplementing with artificial nutrition as directed by a healthcare professional. If people have dentures, bring them in and ensure they fit properly. Let staff know about the person s preferred foods and snacks. Monitor and treat constipation. Unnecessary procedures such as inserting a tube into the bladder should be avoided. Get people up and about as soon as possible after surgery, providing walking aids. Encourage all people, including those unable to walk, to carry out active range-of-motion exercises. 7

8 Caring for Patients with Delirium: What Staff at UHL can do Provide appropriate lighting and clear signage. A clock and a calendar should also be easily visible. Reorientate the person whenever possible; this includes explaining where they are, who they are, and what their role is. Encourage activities that exercise the mind (for example, reminiscence) and regular visits from family and friends. Encourage and assist the person to drink fluids and eat. Recognise and treat constipation. Monitor the patients oxygen levels and treat as necessary. Look for and treat signs of infection. Unnecessary procedures such as inserting a tube into the bladder will be avoided. Get people up and about as soon as possible after surgery, providing walking aids. All people, including those unable to walk, should be encouraged to carry out active range-ofmotion exercises. For those patients who take multiple medications a check on what medicines they are regularly taking will be carried out and wherever possible reduced in number. All patients will be assessed and have any pain managed. Staff will ask you to fill in patient profile to know the person as a whole. 8

9 What you can do to help whilst your relative is in hospital Please bring in their dentures, glasses and hearing aids. Inform the medical/nursing staff if you are concerned about a change in your relatives or care users memory or behaviour. Visit regularly if you can and stay calm and try to reassure them. Visitors should be limited to just one or two at a time. Larger groups can be too much for a confused person. Plan a visiting schedule with other family members and friends. Help us to reorientate them when you can - remind them of where they are, what is happening and of the time and date. Bring in familiar things from home such as favourite pictures, books, or other objects. Encourage them to eat and drink by bringing in their preferred foods or snacks or letting the nursing staff know of any food preferences. If possible visit at mealtimes so you can encourage your relative to eat and drink. Please leave objects that are easily broken or that are irreplaceable at home. Bring in tapes/cds of the person s favourite music. If the music is quiet and light, it can be soothing. Please avoid bringing in a radio or using a television as the added voices and images may contribute to the confusion. Bring in a book for family and friends to sign whenever they visit, including the date and time of their visit. This may help your relative remember their visitors. 9

10 Communicating with people with delirium Tell the person who you are each time you visit. If you leave the room for even a short time, identify yourself again when you come back. Tell the person where they are and what date and time it is. Speak slowly and softly, but do not whisper. Use a warm and reassuring tone of voice. Be prepared to repeat phrases several times. Keep sentences very short and use simple words. Give the person enough time to absorb the information and to respond. Reassure the person that you understand they are having a confusing and frightening experience, but that they will get better. Listen carefully. Even if the content of the confused person s conversation makes no sense to you, you may still understand the emotion being expressed. Respond to that emotion. Do not correct or argue with a confused person. This will not reduce confusion and will upset everyone concerned. Do not speak to others about the confused senior as if he or she is not there. Try to include the confused person in all conversations. Sometimes a confused person may say things that are very hurtful. Although it s hard, try not to take these comments personally. Remember it is the confusion speaking, not the person. Questions are a good way of communicating, but need to be simple in the first instance so that a Yes or No answer can be given or a gesture. 10

11 On discharge from hospital Delirium is distressing for everyone but once the underlying cause has been treated things usually improve. Some people who are recovering from delirium may still be a little more confused than they are normally when they are discharged home. This is because we recognise that being cared for in a familiar home environment can often bring on further beneficial improvements and people can be supported in the community. In a small number of people their delirium may not resolve and in these cases alternative diagnosis such as depression or dementia should be investigated. If you are at all concerned after discharge you should contact your GP. Questions and contact numbers 11

12 Support for carers and families University Hospitals of Leicester (UHL) Patient Information and Liaison Service (PILS) Whether you have a query, concern, need some information or wish to make a formal complaint about the services provided by UHL, PILS are here to help. They will liaise with hospital staff or departments and other relevant organisations to resolve the issue you raise as quickly as possible. They can also advise you about how to make a formal complaint about our service. Freephone: Fax: pils.complaints.compliments@uhl-tr.nhs.uk Or via their website form at 12

13 External Sources of Information and Support The Alzheimer s Society A membership organisation which provides advice and support on all forms of dementia and caring for a person with dementia. Telephone: Website: CLASP (Carers of Leicestershire Advocacy and Support Project) The Carers Centre A registered charity set up to support carers in Leicester, Leicestershire and Rutland and provide quality service carers such as advocacy and support, information and advice, training and a chance to meet other carers. Telephone: Website: Age Concern Age Concern Leicester Shire and Rutland is a locally managed and independent charity that provides a wide range of direct services and support that improves and maintains quality of life for older people and their carers. Telephone: Website: Carers UK Carers UK is a charity set up to help those who care for family and friends. Telephone: Website: 13

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16 If you would like this information in another language or format, please contact the service equality manager on Haddaad rabto warqadan oo turjuman oo ku duuban cajalad ama qoraal ah fadlan la xiriir, Maamulaha Adeegga Sinaanta Eĝer bu broşürün (kitapçıĝın) yazılı veya kasetli açıklamasını isterseniz lütfen servis müdürüne telefonundan ulaşabilirsiniz. Produced: May 2012 Review: May 2014 (Dennis) KR MED