1. Agnes is in a muddle Agnes is an 84 year old lady who has been living at your home for 4 years. Recently the home changed the soap powder used to wash residents’ clothes, and Agnes had an allergic reaction to this. She was given an antihistamine for this which she started taking 2 days ago. On your last 2 night shifts you have noticed that Agnes seems restless in the evening, and often picks at her bedclothes and moans in the night. When you talk to her, she seems to find it hard to follow what you are saying to her, and she keeps jumping from one topic to another. You mention this at handover, and though the afternoon staff agree with you that she seems a bit confused, the morning staff comment that she does not seem so bad in the morning. What are the signs that she might be delirious? What could be the cause of delirium?

2. Is Harold OK? Harold is an 82 year old man who has been living at your home for 5 years. He has a diagnosis of Alzheimer’s dementia. He has a catheter. Harry does not wear a hearing aid, but over the past week you have noticed that he has been asking you to repeat what you have said, and sometimes seems to mishear you completely. Over the last couple of days he has been eating and drinking much less than usual, and sometimes you have noticed him rubbing his stomach. What are the risk factors for delirium?

3. There’s something not right with Mrs Wright Mrs Wright has recently come to live at your home following a period of hospitalisation for a fractured hip. Her family report that previously she was independent, if a little forgetful at times, and coped living at home with the support of meals on wheels. Following her operation, Barbara became acutely confused, shouting and trying to get out of her bed at night. She was found to have developed an infection in her wound site and was given antibiotics to treat this. She was also prescribed Lorazepam which staff said settled her and stopped her shouting out at night. On discharge, hospital staff and her family agreed that they did not feel that Mrs Wright would be able to manage living by herself, and she was transferred to your home. Since coming to your home Mrs Wright has seemed quiet and withdrawn. She does not seem to know where she is, and has been trying to get out of bed to wander round several times at night. You have heard her mumbling to herself in the evenings, but it is hard to make out what she is saying. What questions might you ask?

4. Lorna is not herself Lorna has been a resident at your home for the past 8 years. Although she first moved to the home she initially seemed very withdrawn, over the years she seems to have enjoyed living here and has made some good friends. Over the last few months, Lorna has become increasingly withdrawn and she no longer seems to want to engage in conversation. She does not seem to be sleeping well and she seems more forgetful than usual. Her appetite is reduced and needs several prompts to wash and dress in the mornings. At the beginning of the year, one of her good friends in the home died. Six months ago another friend in the home moved to a different unit due to worsening dementia. Recently a staff member who Lorna got on very well with was offered a new job in another home. Depression or Delirium? What are the risk factors for Delirium?