1 in 3 cases of delirium are misdiagnosed worldwide

13th March 2019

“Misdiagnosed delirium is leading to poorer outcomes for patients, longer stays in hospital, malnutrition and higher risk of death.” said Dr. Rosa McNamara, Consultant in Emergency Medicine (specialising in care for the elderly), from St. Vincent’s University Hospital – at the launch of the hospital’s education day for World Delirium Awareness Day (Wednesday, March 13th).

“Delirium is a form of acute brain failure and an emergency situation – and an indication –always- that the patient is ill. Everyone needs to know the symptoms and act fast – and this often starts with the patient’s family member who knows them better than anyone.” said Dr. McNamara.

“We need to change the conversation about delirium, recognise how serious it is and educate ourselves much more – and this starts by making a few simple changes. Firstly our language needs to change and we need to dispense with- often light hearted – terms like “delirious with happiness,” “pleasantly confused” all of which suggest that clinical intervention is optional – which it isn’t. Secondly, we need to understand that the most common form of delirium is one where the patients sit alone quietly without bothering anyone, and don’t seem too unwell. They often don’t ask for painkillers, forget to eat and drink, and don’t speak – all of which can be so easily missed.”

“Thirdly” Dr. McNamara continued, “we need to recognise that delirium is a complication that not only affects older people, but can also can occur in any age group.  In younger people, it is most common after severe illness or trauma and is frequently seen in patients who are in an intensive care unit and in post-operative care in all age groups.”

St. Vincent’s University Hospital is running an education day on Wednesday 13th March to ensure everyone is aware of the symptoms: “Everyone in the hospital can help to watch out for the symptoms of delirium – the porter, catering staff, cleaner, radiographer or anyone else who interacts with patients. The sooner delirium is diagnosed, the earlier we can treat the cause, which might be infection, medications, dehydration, pain, low oxygen levels, or many other possibilities” says Dr. McNamara.

Facts about Delirium

What is Delirium?

Delirium is defined as an acute change in cognition that cannot be better accounted for by a pre-existing or evolving dementia – consider it a form of organ failure. It affects up to 25% of older patients in hospital but can happen at any age. It frequently presents itself as a sudden change in memory which can happen rapidly over a period of hours or days.

There are three main types; hyperactive, hypoactive and mixed. In hypoactive or ‘quiet delirium’ people seem withdrawn, drowsy or lethargic while in hyperactive they may be restless, agitated or combative.  Hypoactive and mixed delirium are the most common and account for 96% of all delirium.

What are the risk factors?

Risk factors include a history of previous episodes of delirium, history of memory problems, poor hearing or vision, movement to a new environment, some medications, and some diseases like fractured hip.  People who are very sick regardless of their age will often experience delirium and it is very common in people who are admitted to intensive care.

What are the symptoms of delirium?
Poor attention
Confused/disorganised thinking
Altered level of consciousness
Sometimes people experience hallucinations (seeing or hearing things that are not there)

 

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