Delirium
In late April*, the US Centers for Disease Control and Prevention updated its list of COVID-19 symptoms. The CDC initially listed fever, cough, and shortness of breath as the defining clinical aspects of COVID-19, but the agency now recognizes that:
Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Among seniors, a COVID-19 infection can be accompanied by disorientation and confusion. Researchers from the University of Lausanne Hospital published clinical guidelines in the Revue Medicale Suisse (translated using Google Translate) for diagnosing elderly patients with COVID-19.
The common symptoms they highlight include:
* The Centers for Disease Control and Prevention has added several new symptoms to its existing list of symptoms for COVID-19.The CDC has long said that:
When to Seek Emergency Medical Attention
Look for emergency warning signs* for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:
* This list is not all possible symptoms. Please call your medical provider for any other symptoms that are severe or concerning to you.
Call 000 or call ahead to your local emergency facility. Notify the operator that you are seeking care for someone who has or may have COVID-19.
13 May 2020
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Living with a diagnosis of dementia can make many older people at increased risk to other health conditions, infections and falls.
Research shows that due to this increase people with dementia also have multiple hospital admissions, more so than those without the condition.
A recent research has looked into the rates of readmission of older people, and how hospital stays can impact people’s health. Statistics show that about 25 per cent of older adults admitted to hospitals have dementia and are at increased risk for serious problems like in-hospital falls and delirium.
Because of their increased risk for delirium and falls, these older people likely to do poorly during hospital stays compared to older adults without dementia.
It is not uncommon for people with dementia in general to struggle with agitation after admission, due to change to their environment and medication.
Many are often confined to their bed or are physically restrained for safety and, for many, this limitation and overall impact on their comfort can result in a decline in their physical and cognitive functions.
https://hellocaremail.com.au/dementia-increases-hospital-readmission-risk/?
---------------------------------------------
https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/cognition/delirium/delirium-serious
Watch for any new change or worsening of mental function or confusion, which could be a sign of delirium. Delirium often flags an infection in older adults, especially those with dementia. Delirium is a brain-related condition where there is a change in a person’s thinking, and behaviour can come and go. The person often has difficulty paying attention, may be very sleepy or restless, or be thinking in a disorganized way.
Delirium and Dementia:
https://www.dementia.org.au/files/helpsheets/Helpsheet-DementiaQandA21_Delirium_english.pdf
A new study has found that antipsychotic drugs have no effect on delirium, according to a study released 5 November 2018 in the New England Journal of Medicine. Until now, research on the effectiveness of treating delirium with antipsychotics was mixed, despite the fact the medication has been widely prescribed for the condition for over 40 years, both in hospitals and in aged care.
With no convincing evidence to support use of the medication, a team of US researchers set out to get to the bottom of the issue.
“There’s not a shred of evidence in this entire investigation that this aggressive approach to treating delirium with antipsychotics, which is commonplace and usual care, did anything for the patients,” Dr Ely said. Intravenous antipsychotic medications have been used to treat delirium in hospitalized patients for more than 40 years, according to the authors of the study.
Antipsychotic medications are also used widely to treat deliriium in aged care. The recent expose of the aged care industry on Four Corners, ‘Who Cares?’, touched on the issue of antipsychotic over-prescribing in aged care. Rather than using these medications as a last resort, the program said they are being readily prescribed and are often given without family’s approval, despite consent being required. The Four Corners report revealed that one resident ended up in a mental health ward after being prescribed the antipsychotic Risperidone, and other medications, for delirium. This person’s family were only made aware the medication had been given to her after it appeared on her bill.
5 November 2018
ANAESTHESIA for Older People and People with Dementia:
For a long time, there have been anecdotal reports from family members that their older relative “has never been the same since the operation”. This sheet describes the different types of problems that may occur.
https://www.dementia.org.au/files/helpsheets/Helpsheet-DementiaQandA20-Anaethesia_english.pdf
Sudden changes to a person’s normal behaviour such as becoming withdrawn, memory problems, or confusion and restlessness, may be a condition called delirium. Delirium is not madness or dementia, or a disease.
The person with delirium may:
be suddenly different to their normal self;
be quiet, withdrawn and sleepy or very restless and disturbed or fluctuate between the two;
lose the ability to think clearly and logically, or concentrate;
be unable to remember recent events and conversations;
speak in a rambling and incoherent way;
talk about the past as though it were the present;
be quite moody and unstable, for example showing happiness, sadness, or anger all within a short space of time;
see things that aren’t there, but are real to them (hallucinations) and believe things that aren’t true (delusions);
wander around without purpose;
have changes to their sleeping habits, be awake at night and drowsy during the day; or
lose control of their bladder and bowels. The doctor or nurse should be advised of any changes as soon as possible.\
Delirium beyond the basics information here: www.uptodate.com/contents/delirium-beyond-the-basics
More on clinical care at http://www.safetyandquality.gov.au/our-work/clinical-care-standards/delirium-clinical-care-standard/
Is your loved one in hospital? Speak UP!
Delirium is an acute change in mental status that is common among older people in hospital. Hospitals, by nature are difficult environments for people with delirium, dementia or cognitive impairment.
The family's role in this case is one of the most important:
https://www.health.qld.gov.au/__data/assets/pdf_file/0035/639269/2017-delirium-management-guideline.pdf
Information for patients, carers and their families:
Delirium is a common medical problem that is characterized by fluctuating changes in cognitive function. It occurs more often amongst older people. When delirium occurs people are confused and may be either very agitated or quiet and drowsy. The onset of delirium is usually sudden. It usually only lasts for a few days but may persist for longer periods. It can be a serious condition.
Delirium IS a serious condition
“We must recognise and respond to delirium as we would any other medical emergency…[if we don’t] the outcome is as bad for older patients as if they experienced an acute myocardial infarct” (Geriatrician, Clinical Leadership Group on Care of Older People in Hospital)
Delirium is an acute change in mental status that is common among older people in hospital.
Delirium is a serious condition where the person experiences a disturbance in:
Delirium develops quickly and symptoms fluctuate throughout the day. It usually lasts for a few days and can come and go, even with a day or so in between at times, although they are usually more pronounced at night, but may persist for weeks or even months in vulnerable older adults.
Delirium may be the only sign of medical illness or a rapidly deteriorating patient.
Delirium can be hyperactive, hypoactive (‘quiet’ delirium) or mixed.
Hyperactive delirium is characterised by
Hypoactive delirium is characterised by
‘Mixed’ delirium is where people have features of
Delirium symptoms develop quickly
Delirium develops quickly, over hours or days, and symptoms fluctuate throughout the day and are often worse at night.
Symptoms include:
1. Kiely, D., et al., Characteristics associated with delirium persistence among newly admitted post-acute facility patients. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 2004. 59(4): p. 344-9.
2. Dasgupta, M. and L.M. Hillier, Factors associated with prolonged delirium: a systematic review. International Psychogeriatrics, 2010. 22(3): p. 373-394.
with sincere thanks for this most well written article. Sometimes we 'know' that all is not right with our loved one, but while alarmed, do not fully comprehend the seriousness of the condition.
In late April*, the US Centers for Disease Control and Prevention updated its list of COVID-19 symptoms. The CDC initially listed fever, cough, and shortness of breath as the defining clinical aspects of COVID-19, but the agency now recognizes that:
- repeated shaking with chills,
- muscle pain,
- headache,
- sore throat, and
- a loss of taste
- or smell may accompany an infection.
Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Among seniors, a COVID-19 infection can be accompanied by disorientation and confusion. Researchers from the University of Lausanne Hospital published clinical guidelines in the Revue Medicale Suisse (translated using Google Translate) for diagnosing elderly patients with COVID-19.
The common symptoms they highlight include:
- falls and
- delirium in addition to fevers and GI issues.
- The link between infections such as urinary tract infections and delirium in older patients is well-known, though it hasn’t been rigorously investigated.
* The Centers for Disease Control and Prevention has added several new symptoms to its existing list of symptoms for COVID-19.The CDC has long said that:
- fever,
- cough and
- shortness of breath are indications that someone might have the disease caused by the novel coronavirus.
- It has now added six more conditions that may come with the disease:
- chills,
- repeated shaking with chills,
- muscle pain,
- headache,
- sore throat and
- new loss of taste or smell.
When to Seek Emergency Medical Attention
Look for emergency warning signs* for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion
- Inability to wake or stay awake
- Bluish lips or face
* This list is not all possible symptoms. Please call your medical provider for any other symptoms that are severe or concerning to you.
Call 000 or call ahead to your local emergency facility. Notify the operator that you are seeking care for someone who has or may have COVID-19.
13 May 2020
= - = - = - = - = - = - = - = - = - = - = - = - = - = - = - = - = - = - =
Living with a diagnosis of dementia can make many older people at increased risk to other health conditions, infections and falls.
Research shows that due to this increase people with dementia also have multiple hospital admissions, more so than those without the condition.
A recent research has looked into the rates of readmission of older people, and how hospital stays can impact people’s health. Statistics show that about 25 per cent of older adults admitted to hospitals have dementia and are at increased risk for serious problems like in-hospital falls and delirium.
Because of their increased risk for delirium and falls, these older people likely to do poorly during hospital stays compared to older adults without dementia.
It is not uncommon for people with dementia in general to struggle with agitation after admission, due to change to their environment and medication.
Many are often confined to their bed or are physically restrained for safety and, for many, this limitation and overall impact on their comfort can result in a decline in their physical and cognitive functions.
https://hellocaremail.com.au/dementia-increases-hospital-readmission-risk/?
---------------------------------------------
https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/cognition/delirium/delirium-serious
Watch for any new change or worsening of mental function or confusion, which could be a sign of delirium. Delirium often flags an infection in older adults, especially those with dementia. Delirium is a brain-related condition where there is a change in a person’s thinking, and behaviour can come and go. The person often has difficulty paying attention, may be very sleepy or restless, or be thinking in a disorganized way.
Delirium and Dementia:
https://www.dementia.org.au/files/helpsheets/Helpsheet-DementiaQandA21_Delirium_english.pdf
A new study has found that antipsychotic drugs have no effect on delirium, according to a study released 5 November 2018 in the New England Journal of Medicine. Until now, research on the effectiveness of treating delirium with antipsychotics was mixed, despite the fact the medication has been widely prescribed for the condition for over 40 years, both in hospitals and in aged care.
With no convincing evidence to support use of the medication, a team of US researchers set out to get to the bottom of the issue.
“There’s not a shred of evidence in this entire investigation that this aggressive approach to treating delirium with antipsychotics, which is commonplace and usual care, did anything for the patients,” Dr Ely said. Intravenous antipsychotic medications have been used to treat delirium in hospitalized patients for more than 40 years, according to the authors of the study.
Antipsychotic medications are also used widely to treat deliriium in aged care. The recent expose of the aged care industry on Four Corners, ‘Who Cares?’, touched on the issue of antipsychotic over-prescribing in aged care. Rather than using these medications as a last resort, the program said they are being readily prescribed and are often given without family’s approval, despite consent being required. The Four Corners report revealed that one resident ended up in a mental health ward after being prescribed the antipsychotic Risperidone, and other medications, for delirium. This person’s family were only made aware the medication had been given to her after it appeared on her bill.
5 November 2018
ANAESTHESIA for Older People and People with Dementia:
For a long time, there have been anecdotal reports from family members that their older relative “has never been the same since the operation”. This sheet describes the different types of problems that may occur.
https://www.dementia.org.au/files/helpsheets/Helpsheet-DementiaQandA20-Anaethesia_english.pdf
Sudden changes to a person’s normal behaviour such as becoming withdrawn, memory problems, or confusion and restlessness, may be a condition called delirium. Delirium is not madness or dementia, or a disease.
The person with delirium may:
be suddenly different to their normal self;
be quiet, withdrawn and sleepy or very restless and disturbed or fluctuate between the two;
lose the ability to think clearly and logically, or concentrate;
be unable to remember recent events and conversations;
speak in a rambling and incoherent way;
talk about the past as though it were the present;
be quite moody and unstable, for example showing happiness, sadness, or anger all within a short space of time;
see things that aren’t there, but are real to them (hallucinations) and believe things that aren’t true (delusions);
wander around without purpose;
have changes to their sleeping habits, be awake at night and drowsy during the day; or
lose control of their bladder and bowels. The doctor or nurse should be advised of any changes as soon as possible.\
Delirium beyond the basics information here: www.uptodate.com/contents/delirium-beyond-the-basics
More on clinical care at http://www.safetyandquality.gov.au/our-work/clinical-care-standards/delirium-clinical-care-standard/
Is your loved one in hospital? Speak UP!
Delirium is an acute change in mental status that is common among older people in hospital. Hospitals, by nature are difficult environments for people with delirium, dementia or cognitive impairment.
The family's role in this case is one of the most important:
- The nurse or doctor does not know your loved one, like you do.
- It may be the first time they have ever cared for them also.
- Your role is critical.
- Clinician’s need to hear exactly how your loved one was functioning physically and cognitively before admission.
- Over what period you have noticed a decline in their abilities,
- what is normal for them and
- what is not.
- As this will help make a more accurate and hopefully quicker diagnosis.
- You are their advocate, you are their voice when they cannot communicate articulately or report what has been happening.
- Don’t feel as though you are being a ‘difficult family’. Nothing else matters but the welfare for your loved one, so speak up and be sure you are listened to.
- If you are concerned about someone who is at risk and wish to find out more, contact Alzheimer's Australia at their National Dementia Helpline on 1800 100 500.
https://www.health.qld.gov.au/__data/assets/pdf_file/0035/639269/2017-delirium-management-guideline.pdf
Information for patients, carers and their families:
Delirium is a common medical problem that is characterized by fluctuating changes in cognitive function. It occurs more often amongst older people. When delirium occurs people are confused and may be either very agitated or quiet and drowsy. The onset of delirium is usually sudden. It usually only lasts for a few days but may persist for longer periods. It can be a serious condition.
Delirium IS a serious condition
“We must recognise and respond to delirium as we would any other medical emergency…[if we don’t] the outcome is as bad for older patients as if they experienced an acute myocardial infarct” (Geriatrician, Clinical Leadership Group on Care of Older People in Hospital)
Delirium is an acute change in mental status that is common among older people in hospital.
Delirium is a serious condition where the person experiences a disturbance in:
- attention,
- perception,
- awareness and
- cognition.
- Delirium may be caused by general medical conditions (for example, infections, hypoxia), certain medications, intoxicating substances or a combination of these.
Delirium develops quickly and symptoms fluctuate throughout the day. It usually lasts for a few days and can come and go, even with a day or so in between at times, although they are usually more pronounced at night, but may persist for weeks or even months in vulnerable older adults.
Delirium may be the only sign of medical illness or a rapidly deteriorating patient.
Delirium can be hyperactive, hypoactive (‘quiet’ delirium) or mixed.
Hyperactive delirium is characterised by
- increased motor activity,
- restlessness,
- agitation,
- aggression,
- wandering,
- hyper alertness,
- hallucinations and delusions, and
- inappropriate behaviour.
Hypoactive delirium is characterised by
- reduced motor activity,
- lethargy,
- withdrawal,
- drowsiness and
- staring into space.
- It is the most common delirium in older people.
‘Mixed’ delirium is where people have features of
- hyperactive and
- hypoactive delirium.
Delirium symptoms develop quickly
Delirium develops quickly, over hours or days, and symptoms fluctuate throughout the day and are often worse at night.
Symptoms include:
- difficulty directing, focusing, sustaining or shifting attention
- confusion
- fluctuating or reduced consciousness
- disorientation to time and place (particularly time)
- disturbance of the sleep-wake cycle, for example, agitated or restless at night and drowsy during the day
- impaired recent memory
- speech or language disturbances, for example, rambling speech
- increased or decreased psychomotor activity
- emotional disturbances, for example, fearfulness, irritability, anger, sadness
- hallucinations and delusions
- lethargy and fatigue.
1. Kiely, D., et al., Characteristics associated with delirium persistence among newly admitted post-acute facility patients. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 2004. 59(4): p. 344-9.
2. Dasgupta, M. and L.M. Hillier, Factors associated with prolonged delirium: a systematic review. International Psychogeriatrics, 2010. 22(3): p. 373-394.
with sincere thanks for this most well written article. Sometimes we 'know' that all is not right with our loved one, but while alarmed, do not fully comprehend the seriousness of the condition.