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March 14, 2018
Today, March 14, is the second annual World Delirium Awareness Day. Delirium is an acute confusional state that is the result of a physiological problem like illness, injury, trauma, medication, withdrawal, constipation, dehydration, etc. While anyone can experience delirium, older individuals and those with compromised brain function are most at-risk.
Delirium is a temporary state that should resolve with treatment of the underlying cause, however while many people return to their usual baseline, delirium can have lasting detrimental effects on cognition and function in some patients.
The hallmark of delirium is a poor concentration. This can manifest in many ways like problems in being able to maintain attention, being easily distracted or being unable to follow prompts for tasks.
“What can make diagnosing delirium challenging within a hospital environment is not knowing an individual’s baseline prior to admission,” says Dr. Niamh O’Regan, Geriatrician at LHSC. “It’s incredibly important for us to get that information from someone who knows the patient well, so that we can in-turn identify delirium when it is present and treat it appropriately. Given the adverse outcomes associated with delirium, it must be considered a medical emergency.”
Laurie McKellar, Nurse Practitioner at LHSC adds, “Prevention of delirium is very important because once delirium occurs, the time for the person to recover and how well the person recovers are both totally unpredictable. Prevention-based strategies not only eliminate the adverse outcomes that can occur with delirium, they also simultaneously help optimize the person’s overall health.”
Several initiatives are currently taking place at LHSC to better address delirium. Staff on our Acute Care for the Elderly (ACE) unit created and implemented a Delirium Prevention Checklist which includes several strategies to help prevent delirium from occurring and is completed by nurses daily. Screening for delirium is also occurring in other areas outside of the ACE unit so it can be detected as early as possible. As well, presentations about delirium to staff have occurred on several inpatient units and a delirium working group has been formed.
For Dr. O’Regan the awareness day is a particularly important one and not just for health-care providers.
“We want to widely spread the word about delirium because it remains under-recognised and under-appreciated in terms of its impact. The biggest takeaway for people is that confusion is never normal. If you spot that your loved one has had a change in their thinking or memory that has come on suddenly, it’s important to seek care from a primary care provider, so that the underlying cause can be investigated and treated.”
This year, the awareness day is asking health-care professionals to reflect on their current practice and pledge to change in some way that may help to prevent delirium. At LHSC today information booths at University Hospital (outside of the cafeteria) and Victoria Hospital (B2 atrium and E2 link) will offer staff and physicians the opportunity to fill out a pledge form. The booths will also provide more general information, facts and resources about delirium for all who are interested in learning more.