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Marie Palmer speaks on delirium assessment and assessment of people at risk

Marie PalmerMarie Palmer

Marie began her presentation by looking at what is delirium? This was answered through the following points: 
- Historically seen as a person who is confused/ may have dementia or in an acute confusional state 
- Delirium is characterised by recent onset of fluctuating awareness. 
- Sudden onset of behaviours different to normal- sudden onset of confusion, or increased levels of confusion 
- Marked disorientation, some people also develop strange ideas, or paranoia, and hallucinations. 

Delirium is a common presentation of acute illness, with a higher incidence in older people- the development of delirium is associated with adverse outcomes, including death. Delirium can occur at any age, and can affect around 1 in 8 of all hospital patients and higher incidence of delirium is found in older people.

The presentation furthermore looked at the impact locally - 
- Approximately 25% of all elderly patients admitted to hospital will experience delirium either on admission or during their hospital stay
- Sometimes it is the only presenting symptom of illness in the elderly
- Increase ALOS by average of 8 days
- Risk of adverse events while in hospital are increased; Pressure Ulcers, Falls risk, compromised dignity 
- Residual mental health and cognitive risks at 6 and 12 months post discharge 
1 in 5 dead in one month
- Increased risk of new institutionalisation

Marie asks what the risk factors are? Age 65 and over; have a current fracture; evidence of cognitive impairment- (past or present) and /or dementia; have a severe illness- chronic condition that has potential for deterioration ( e.g. Kidney failure, diabetes); the above increase ones risk factors , especially when combined with some seemingly simple issues.  

Complications of delirium:  
Infections, dehydration, constipation, strokes, heart attacks, recent surgery, excess alcohol, some progress to stupor/ coma with eventual death. 1 in 5 dead in one month. Increased risk of new institutionalisation.  
This list is not exhaustive stressed Tracey. 

- Within the general community only 1-2% of people have delirium, rising to an increase of 14% for those people aged over 85 
- Within acute settings the risk of developing delirium rises, with estimates of 
- A& E departments 14-24% of people attending
- Post operative patients  <50% 
- Acute Elder care pathway <50%
- And ICU with <50%% people experiencing some level of delirium 

The presentation wa concluded with the following key points: 
Delirium is a common and serious disorder that is preventable and treatable, yet all too often the common risk factors are not identified systematically and many delirium cases remain undetected and undiagnosed. 
This places those who are the most vulnerable at higher risk.
Staff development and training is required to reduce assumption, and increase the rate of recognition within acute hospitals.  

Delirium can persist for weeks or months after the cause is treated 
The Hypoactive form and mixed type are more common than the hyperactive type of delirium 
With little or no public recognition of delirium, the bedside nurse is in a key position to make an episode of delirium less distressful for the both the patient and the family.
Following a period of delirium people can have mixed responses, and may need extra support.
With robust,  better systems of routine care, delirium could be prevented in at least a third of patients. 


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Events of Interest:

CQC Inspections in Mental Health & Community Care
Monday 22 September 2014, London
Masterclass: Deprivation of Liberty Safeguards
Wednesday 24 September 2014, London
Improving Mental Health Crisis Care
Friday 17 October 2014, London
Psychosis & Schizophrenia in Adults
Monday 10 November 2014, London
Smoking Cessation in Mental Health
Monday 10 November 2014, London

Download: Marie Palmer's Presentation

18 July 2014


    Partner Organisations

    The Tavistock and Portman NHS Foundation TrustInPracticeClinical Audit Support CentrePlayoutJust For Nurses
    GGI (Good Governance Institute) accredited conferences CPD Member BADS (British Association of Day Surgery) accredited conferences