09/13/11

 

Milta Little, DO, a St. Louis-based physician and assistant professor at the St. Louis University School of Medicine, talks about delirium and how recognizing it early makes a big difference.

Delirium, a sudden change in brain function that happens when someone has a physical illness, usually is temporary and can be resolved. Watching a family member/friend suffer from delirium is upsetting. A normally alert, sharp person can become confused or forgetful, talk gibberish, act strange, or think he/she sees things that aren?t there. It is important to address delirium quickly. You can help by watching for signs of this condition and reporting them promptly to a nurse or other clinical team member.

Your family member/friend may be at risk for delirium if he/she: has a history of behavioral problems or mental changes, is taking medications that can cause behavior or mental changes, has a fever or infection, has just had surgery, or has an illness such as dementia, schizophrenia, or bipolar disorder.

As someone who knows the person best, you can recognize problems early. Red flags include a sudden or big change in behavior, attitude, personality, or mental alertness. For example, Dad is normally soft-spoken and polite, but today he is angry and yelling. By reporting your concerns right away, you can helpprevent a fall or accident and/or keep the person from having to go to the hospital. This is important because a hospital stay can be costly and increase the risk for pressure ulcers or other problems.

Delirium treatment depends on the underlying causes, other conditions the person has, how it affects the person?s behavior, and patient/family preferences. If the person?s delirium-related behaviors put him/her and/or others at risk, managing the behavior will be a top priority. Several possible approaches focus on addressing the behavioral problem without drugs. These includeeasing pain, decreasing noise, providing activities the person enjoys, and using approaches to activities of daily livingthings such as bathing that are as stress freeand easy as possible for the person.

Questions to Ask Your Physician:

--Is my family member/friend at risk for delirium? What possible changes in condition could cause this?

--How can I tell the difference between delirium and other problems or my family member/friend having a "bad" or "off" day?

--Does delirium mean that my family member/friend is seriously ill?

--What will happen if my family member/friend becomes delirious? How quickly can it be managed?

--When will delirium cause my family/member friend to have to go to the hospital? What if he/she has a Do-Not-Hospitalize order?

What You Can Do:

--Notify nursing immediately if you notice changes inyour family member/friend?s behaviors, attitudes, personality, memory, or ability to dress, bathe, or walk, or if he/she seems confused, upset, or angry for no obvious reason.

--Make sure staff know about any special fears or pet peeves your family member/friend has. Also let them know about any words or actions that might calm him/her when he/she gets upset.

--Make sure facility staff know how to contact you if there is a change in your family member/friend?s condition.

For more information:

--Delirium: www.aafp.org/afp/2003/0301/p1027.html

--Delirium in the Elderly: www.oceanmedicalcenter.com/OMC/services/aceunit/DeliriumintheOlderAdult.cfm

--Quality Measure Fact Sheet: Short Stay Residents with Delirium: www.amda.com/consumers/delirium.cfm

 

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