How is delirium diagnosed?It’s really important that a person’s delirium is diagnosed quickly. Delirium is a serious condition and is linked to severe problems if it isn’t treated. Show
A healthcare professional such as a doctor or nurse will make the diagnosis. To decide if someone has delirium or not, they will consider the person’s clinical history (how their symptoms developed) and examine them. They will use a quick test known as a 4AT. The 4AT test measures someone’s:
A doctor or nurse may assess someone’s mental state each day in hospital. Or they may do so when the person moves from one place to another, for example from a hospital to a care home. If they find that the person has delirium, they should tell the person’s close family. Health or social care staff involved in their care might suspect that the person has undiagnosed dementia, but will not assess them for this until their delirium is over. If they are in doubt, they will treat the delirium first as this needs treating more urgently. Even in hospital it can be difficult for delirium to be spotted and diagnosed. This is another reason to tell staff if you notice a change in the person you care about. As well as diagnosing the person’s delirium, healthcare professionals will do other tests to work out what has caused the delirium. For example, they may take blood samples or possibly a chest x-ray. This is important because treating the cause of the delirium will usually help the person’s symptoms improve or go away. Who gets delirium and why?Delirium is common, particularly among older people in hospital. It’s usually the reaction of the brain to a separate medical problem (or several medical problems at once). Problems that can cause delirium include:
Anyone can get delirium, but the following factors put people at higher risk:
Delirium is common in older people in hospital, because they are unwell or may have had an operation (for example, hip or heart surgery). Hospital staff should speak to the patient and family beforehand about the risk of delirium after the operation. Intensive care is another very common cause of delirium in hospital. Delirium is also quite common in residents of care homes, or in older people with dementia at home. They are more likely to be frail, have several health conditions and be taking several medicines. When someone goes into hospital or a care home, it’s helpful if they have a completed or updated copy of a form such as This is me with them. Care staff can refer to this for information about the person, which will be particularly helpful if they get delirium during their stay. With the right care, some cases of delirium can be prevented. Soon after a person comes into hospital or long-term care, staff should check whether they are at risk of delirium. If they are, there are non-drug approaches to help prevent delirium that should be put in place, including those described below. What is treatment and support for delirium?Delirium is treated first by addressing the medical problem(s) that have caused it. For example, if the person has low blood oxygen or low blood sugar levels these will be corrected quickly. If the person has an infection they may be given antibiotics. If they are in pain, constipated or not passing urine then these will be treated. Doctors will also review the person’s medication and stop any non-essential drugs that may be linked to delirium. Staff will make sure the person is supported to eat and drink regularly. Delirium will usually improve if its cause is found and treated. A supportive and calm environment can also help someone recover from delirium. Nursing staff, and visiting family and friends, can all help by:
Doctors won’t normally give someone medication to treat delirium, because there is very little evidence that drugs help. Drugs should be considered only if the person’s behaviour (for example, severe agitation in hyperactive delirium) poses a risk of harm to themselves or others, or if hallucinations or delusions are causing the person severe distress. In either case a doctor may try a low dose of a sedative or an antipsychotic for a few days. (Doctors won’t give an antipsychotic to a patient with Lewy body dementia, because of the risk of side effects.) After deliriumThe symptoms of delirium get better in most people over a few days to weeks, once the underlying cause is treated. However, delirium usually means a person will have to stay longer in hospital. When they do leave, their medical notes and their care and support plan should record their delirium and include what further support they will need. Although some people recover fully, delirium can also have lasting consequences after it has been treated. These are more common in older people.
These complications are more likely after delirium but they’re not inevitable. However, they do mean it’s important to be aware of delirium and try to prevent it where possible. What is the distinguishing factor between delirium and dementia?Delirium is an abrupt onset of reduced orientation to the environment in contrast to dementia, a gradual neurodegenerative process leading to the disturbance in the core features, and attention is affected much later in the disease course.
Which of the following is a feature of delirium that can help differentiate it from dementia quizlet?Delirium may also present with hypoactive symptoms, such as inability to converse, focus attention, or follow commands, as in the presented patient MM, which should be differentiated from dementia or depression.
What are the similarities between dementia and delirium?Delirium and dementia are two separate mental states that can be characterized by impaired memory and judgement, confusion, disorientation, and variable degrees of paranoia and hallucinations.
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