1. Why all the confusion? Dr Thomas Jackson @delirious_dr
Clinical Scientist in Geriatric Medicine
Honorary Consultant Geriatrician, QEHB
Age Well 1/9/16

2. Do you understand the term ‘delirium’?
Yes No

3. Experience of someone being ‘mithered’, ‘muddled’, ‘confused’ with a water infection?
Yes No

4. Delirium
So, I am here to talk to you about delirium – but why? Well, it is a condition that affects at least 1 in 5 older people in hospital, is a marker of not doing well in hospital, is often confused with dementia, is not dementia, but can be associated with dementia. Despite this we know very little about it, but it is both preventable and treatable. It is very often not recognised by health care staff and assumed to be ‘normal’ for older people
It’s often confused with dementia, or assumed to be normal – what do you expect when old people get ill?

5. I’d like to show you this short video, produced by colleagues in the North East (so excuse the accents!) specifically for the public

6. Do you understand the term ‘delirium’?
Yes No

7. Sudden change in mental function
Usually associated with infection but lots of causes
Quiet (Hypoactive)
Noisy (Hyperactive)
Anyone can get it, but fragile older people with brain diseases more at risk

8. Delirium

9. Delirium

10. Head injury

11. Mental change ‘confusion’
Brain inflammation +
Brain failure
Altered alertness
Mental change ‘confusion’

15. Chest infection +
Inflammation

16. Cytokines - messengers
Chest infection +
Inflammation

17. Mental change ‘confusion’
Brain inflammation +
Brain failure
Altered alertness
Mental change ‘confusion’
Chest infection +
Inflammation

18. Ronnie’s problems started almost immediately after he
came round from the one-hour operation in
November 2011.
His recollections are, thankfully, vague. ‘I woke up and the
room was strange, all back to front,’ he says. ‘I don’t remember what happened or what I did – but apparently I did behave very badly.’
In fact, as Anne explains, he was found wandering the corridors of London’s private Princess Grace Hospital in his backless surgical gown. ‘Poor Ronnie didn’t know where he was,’ she recalls. ‘The nurses said it was probably a reaction to the anaesthetic and he was very confused. He ripped out all the various tubes attached to him, jumped out of bed, and ran off down the corridor.
18/1/2014 Daily Mail
It was almost goodnight from me... after getting a new knee! Ronnie Corbett came close to death when he collapsed after having a joint replacement
This illustrates the impact of delirium – it is distressing and casues worry for all involved. We also know that people who have delirium are more likely to not recover well from their illness and are at a higher risk of developing dementia
Read more:
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19. What happens to people with delirium
Usually lasts 2-4 days with good recovery In some people it can persist for months Higher risk of not recovering as well Higher risk of developing memory problems such as dementia

20. How we treat it
Recognise it – call it out Treat the underlying cause (s) Manage distress and keep safe

21. How we prevent it
Recognise high risk situations Older people with dementia or frailty Significant illness, surgery, change in drugs Address simple things Keep hydrated Ensure meds reviewed (especially brain meds) Keep mobile, seeing and hearing Quiet environment, good sleep

22. Recognise high risk situations
Older people with dementia or frailty
Significant illness, surgery, change in drugs
Address simple things
Keep hydrated
Ensure gets usual meds (especially brain meds)
Keep mobile, seeing and hearing

23. What you can do
Be aware – especially at times of high risk Advocate and communicate “This is not my Albert” “Its not normal” “Is it just a water infection?” Bring in glasses, hearing aids, pictures Monitor improvement

24. Delirium starts slowly, gets progressively worse, and cannot be reversed
Yes?
No?

25. Delirium is what you should expect when you are older
Yes?
No?

26. Delirium is preventable and treatable
Yes?
No?

27. European Delirium Association
Websites
Royal College of Psychiatrists
Age UK
Alzheimer’s society GP
European Delirium Association