South London and Maudsley NHS Foundation Trust DELIRIUM Information for relatives and carers Page
Delirium "After her hip operation, my mother became very confused and aggressive. She kept pulling out her drip and shouting at the nurses. It was a shock as she is usually so polite". "We can often tell that my father is getting a water infection because he starts to get slower and becomes quiet and withdrawn. He also sleeps much more". "My wife has mild dementia, but we usually manage fine at home. She still recognises most of our neighbours and friends. When she was in hospital though, she didn't even recognise me or our daughter". "The nurses told me that my grandmother had been up all night, wandering around the ward and trying to leave. However, when I visit her on the ward in the daytime, she is nice and quiet and seemed okay". "In the days leading up to my father's death, he became very confused. He was sleepy at times and agitated and restless at other times. The nurses gave him medication to help control his symptoms". These patients are all suffering from delirium. Page 2
Index CONTENTS PAGE 4: What is delirium? PAGE 5: What are the symptoms? PAGE 7: Who is most at risk? PAGE 8: What are the most common causes? PAGE 9: Can delirium be treated? PAGE 12: Medication PAGE 13: Carers - looking after yourself PAGE 14: Useful contacts This leaflet has been written to help you understand: the symptoms of delirium how it is caused how it can be identified and treated how it can affect people. If you have any questions after reading this leaflet, please speak to one of the doctors or nurses. Page 3
What is delirium? Delirium is a common but serious medical condition. It is also known as an 'acute confusional state'. Delirium is a syndrome, which means that it is a term (word) used to describe many different behaviours and symptoms. Delirium can affect someone's memory, the way they think or the way they see (perceive) the world around them. It can also cause them to behave strangely or out of character. Delirium can affect over 30% of older people during the course of their stay in hospital. Symptoms of delirium are also very common amongst people in their own homes or amongst those living in nursing or residential settings. There are many causes (see page 8). Some people are more at risk of developing the symptoms of delirium (see page 7). Page 4
What are the symptoms? There are many different symptoms of delirium and not everyone experiences the same problems. It is important to remember that these symptoms appear rapidly (within a few hours to a few days) and may change (fluctuate) over a 24-hour period. Delirium can be described as being either "hypo-active" (when you might become more withdrawn or quiet) or "hyper-active" (when you might become more restless and alert). Someone might experience either or both types at the same time. For example, someone: might say or do things that are out of character and a person who is normally quiet and polite may begin to swear and shout for no obvious reason. may become more confused and unable to remember simple information or concentrate on things could forget where they are (disorientation) and they may not recognise family or friends can become physically or verbally aggressive because they misunderstand the things that are happening around them might become more withdrawn and isolated (these symptoms can often be mistaken for depression) Page 5
What are the symptoms? can also become suspicious about people or objects around them (paranoia) and they may feel threatened, frightened or in danger could report seeing, feeling, tasting, smelling or hearing things that are not there and that no one else is aware of (hallucinations) can wander and appear restless or agitated for no obvious reason can appear to be 'normal' one minute and then act completely differently the next (their behaviour fluctuates) might be at higher risk of falling over, particularly if there is a history of falls, but also because they may be more restless or confused. Delirium is not the same as dementia although some of the symptoms and behaviour can be the same. Page 6
Who is most at risk? Some people are more at risk from developing delirium than others including: those who have had recent surgery, particularly hip surgery someone with a diagnosis of a dementia (eg Alzheimer's disease) or a history of memory problems people who are severely unwell or dying anyone over 65 years of age. Page 7
What are the most common causes? There are many causes for delirium and some of the most common causes include: infections (for example, urine and chest infections) dehydration (not drinking enough) taking certain types of medication (for example, some types of painkillers, steroids or medicines for Parkinson's disease) constipation (unable to open your bowels easily) being in severe pain the use of recreational drugs problems for people with a head injury or after suffering a stroke a history of drinking large amounts of alcohol, particularly if someone stops drinking abruptly. It is important not to stop taking any prescription medicines or treatment without first speaking with your doctor. Page 8
Can delirium be treated? Prevention is better than cure. If you have any worries about yourself or your relative, please talk to us. We can all help to prevent or improve the care of patients with delirium by doing simple things. Ensure that: the person is drinking plenty of fluid (up to two litres each day, unless doctors have told them to drink less) the person is wearing their glasses, dentures and hearing aids staff are told if the person suffers from any side effects when taking certain medicines (or if you are allergic to any drugs) staff know about any memory problems staff know about previous episodes of delirium the person takes pain killers when needed staff know if there are any problems going to the toilet (for example, because of pain or constipation) the person gets a good night's sleep and keeps active during the daytime. Page 9
Can delirium be treated? Staff and carers can help someone with delirium by: encouraging them to eat and drink enough (please tell staff if they dislike or are allergic to certain food and drink) making sure that they are wearing their glasses, dentures or hearing aid making sure that they introduce themselves and orientate the person (for example, reminding them that they are in hospital, or reminding them of the time and day) minimising the number of times they need to be moved to different wards or beds reviewing medication and stopping any drugs which are unnecesary or which might make the delirium worse looking out for and treating infections and constipation encouraging them to sit out of bed and exercise during the daytime keeping them free from pain giving them clear explanations about their care and treatment speaking slowly and in short sentences and repeating the information if necessary not agreeing (colluding) or arguing with them if they have strange or unusual beliefs - tactfully disagree or change the subject Page 10
Can delirium be treated? keeping them occupied with the television, radio, newspapers or chatting with visitors writing down information if they are too restless or distressed to remember it (so that they can read it later when they are more settled) having familiar photographs and belongings around them (if they are in hospital, please speak to the nursing staff first) assessing the risk of harm and taking actions to reduce those risks (for example, if someone is restless and at risk from falling, the nursing staff might care for them on a special low bed or put bed rails up to stop them rolling out and injuring themselves) remaining calm and caring for them in a clean, safe and quiet environment. These things are important when trying to reduce how long a delirium will last for and how severe the symptoms are, if they occur. The symptoms can last for a few days or up to several weeks, depending on the cause, the treatment and the person's general health. If the symptoms are settling (resolving), there is no reason why the person cannot be discharged home to complete their recovery. However, before this happens, we will aim to discuss the discharge plans with the person and their relatives. Page 11
Medication Usually, the symptoms of delirium will improve when the cause is treated. But, during the worst stages, the symptoms might be very distressing or might cause someone to become aggressive or restless. If this is the case, the doctors might use medication to help treat the distress and the upsetting symptoms. This medication might also help to calm the person so that essential medical treatment can be given (for example, antibiotics, fluids or oxygen). If any new medication is started, the nurses or doctors would be happy to discuss this with you. If you would like more information about this treatment or any medication that is prescribed, you can speak to one of the doctors or nurses. If you would prefer, we can also give you written information. Page 12
Carers - looking after yourself Looking after a partner, relative or friend can be stressful and tiring. It can also be rewarding and fulfilling. It is important that you look after your own health and have time away from the caring environment. There are many agencies which can offer free advice and practical support on matters such as: financial and benefit reviews 'sitting services', allowing you to leave the home for a few hours whilst a trained volunteer stays with your relative transport and taxis day centres and clubs medicines and treatments carer support groups and counselling respite care. Some local councils have funds for carers and the people they care for to take short breaks or holidays. Talk to your family, GP, social worker, community nurse or telephone a support line for further information (such as Carers UK). If you have a social worker, you should be entitled to a Carers Assessment to look at the help that you are entitled to. Page 13
Useful contacts Carers UK provides advice, information and support for patients, carers and their families. Telephone: 0808 808 7777 Website: www.carersuk.org NHS Direct provides information and advice on medical symptoms, treatment and medication. Telephone: 0845 4647 Website: www.nhsdirect.nhs.uk Age UK provides advice, information and support for older people. Telephone: 0800 169 6565 Website: www.ageuk.org.uk The Royal College of Psychiatrists with information on common mental health conditions. Website: www.rcpsych.ac.uk National Institute for Health and Clinical Excellence (NICE) advice and guidance on treatments and illnesses (including delirium) Website: www.nice.org.uk Carers Direct is an NHS site with practical advice and local information for carers. Telephone: 0808 802 0202 Website: www.nhs.uk/carersdirect/pages/carersdirecthome.aspx The Princess Royal Trust for Carers offering advice and support to carers and patients. Website: www.carers.org The Alzheimer's Society for a variety of fact sheets, information and support. Website: http://alzheimers.org.uk Page 14
Notes Page 15
South London and Maudsley NHS Foundation Trust Options available If you d like a large print, audio, Braille or a translated version of this leaflet then please ask us. Useful contact details SLaM Switchboard: 020 3228 6000 SLaM 24hr Information Line - Advice on how to access SLaM Services: 0800 731 2864 Contact our Patient Advice and Liaison Service (PALS) for help, advice and information: T: 0800 731 2864 W: www.pals.slam.nhs.uk E: pals@slam.nhs.uk Complaints If you are not happy about something but not sure if you want to make a formal complaint you can speak to a member of staff directly. Alternatively you can contact the PALS Office on freephone 0800 731 2864. If you decide you want to make a formal complaint this can be done by contacting the Complaints Department: Complaints Department, Maudsley Hospital, Denmark Hill, London SE5 8AZ T: (020) 3228 2444/2499 E: complaints@slam.nhs.uk W: www.slam.nhs.uk www.tfl.gov.uk/journeyplanner For the quickest way to plan your journey anywhere in greater London use journey planner: 020 7222 1234 (24hrs) Date of Publication: Reference: 01/08/2012 lc00005332 Page 14