Pennsylvania Patient Safety Authority analysts identified 446 events for patients experiencing delirium in hospitals between January 2005 and December 2014. Sixty-four of these events resulted in patient harm. Falls were the most common event type in 158 reports followed by adverse drug events (n=71,15.9%) Some common risk factors identified in the reports were: age 65 or older, male gender, preexisting mental impairment, depression and severe illness. Other common factors that can increase the chances of a patient experiencing delirium include: sudden or severe illness or medical condition (e.g., stroke, infection, substance withdrawal);certain medications (e.g., sedatives, narcotics); surgery requiring sedation; and environmental factors (e.g., sleep deprivation). Reports to the Authority involving patients with delirium have increased over time, with an average of 16 events reported per quarter in 2014, compared with 2.5 per quarter in 2005. If you are a caregiver or a loved one to someone who must be in the hospital, it is important for you to know the symptoms of delirium to decrease the risk of harm to the patient.
What is Delirium and How Diffrent is it from Dementia?
Delirium is sudden confusion that comes and goes. People with delirium often have trouble thinking clearly and have difficulty paying attention. Delirium is not a disease. It is a temporary condition that can affect people of all ages, but is more likely to affect older adults. Dementia, however, is an ongoing condition that slowly takes away a person's memory and other thinking skills so that they are eventually not able to perform everyday activities.
Top Potential Precipitating Risk Factors for Delirium Reported to the Pennsylvania Patient Safety Authority 2005-2014
Precipitating risk factors can trigger delirium, especially in patients who are older who already have mental impairments.
Signs and Symptoms of Delirium
- Sudden change in mental function
- Unable to pay attention
- Disorganized thinking, as shown by rambling or unclear speech, confusion, or problem with memory
- Altered level of alertness, ranging from agitated and highly energized to very quiet and lethargic (sleepy)
What Can You Do as a Caregiver?
- Notify your healthcare provider if your loved one appears suddenly confused or if you notice a change in their mood, memory, ability to think or level of alertness.
- Make sure the patient has been assessed by a healthcare professional for any common factors for delirium, particulary if the patient is male, 65 years or older and/or has mental impairment or a severe illness.
- Bring in familiar and favorite items from home; Music, photos and comforting objects such as blankets are especially helpful.
- Provide a detailed medical history of the patient which includes any mental impairment issues.
- Make sure to provide the healthcare professional wiht an up-to-date list of medications the patient is taking (e.g., sedatives or anti-depression drugs).
- Ask that a plan be developed specifically for the patient to prevent delirium, especially if he/she has some common risk factors.
- Make sure the patient has the same caregiver and avoid moving the patient to different locations if possible.
- Make sure the patient has a calendar and clock available to them. Explain where they are, why they are there and who each staff member is and what their role is to the patient.
- Visit the patient often and encourage other family members and friends to visit the patient.
- Provide activities to the patient that encourage brain activity such as discussing events from the past.
- Encourage the patient to eat plenty of food and liquids to prevent dehydration and constipation.
- Make sure any current illnesses or other medical conditions are also treated (e.g., infection, pain and alcohol or other substance withdrawal).
- Remind the patient to wear their glasses and hearing aids, if needed.
- Encourage the patient to get out of bed for meals and to move as much as possible during the day.
- Provide a calm environment and promote normal rest and sleep patterns by keeping the room bright during the day and dark and quiet at night.
For more information on recognizing delirium, go to the 2015 September Pennsylvania Patient Safety Advisory article "Delirium: Patient Safety Event Reporting and Strategies to Improve Diagnosis, Prevention and Treatment" at the Authority's website at www.patientsafetyauthority.org.