Delirium

Delirium is diagnosed when a person becomes increasingly confused and unaware of their surroundings. It is also called a confusional state, and can be acute (short term) or chronic (longer term). It can look like dementia but usually has a much more sudden onset and symptoms often fluctuate so the person may return to their normal self for brief periods of time. It is caused by an underlying medical problem that affects the brain and prevents it from working normally. Almost any physical health problem may present with delirium, although some are more common than others. For example, a chest infection leading to low oxygen levels could present with delirium, or delirium could be due to a urinary tract infection. The most important treatment is to identify and treat the underlying medical problem.  However, while this is being investigated and treated, the person should be in a supportive environment and may require medication to manage their behaviour. The environment should be stable, quiet, and clearly lit, although not too brightly. Reorientation techniques and memory cues such as a calendar, clocks, and family photos may be helpful. The presence of familiar staff and family members is useful, and family members and staff should explain where the person is and what is happening if they seem disoriented or distressed, reinforce this as necessary, and reassure the patient. If the person has hearing or visual impairments, it is important to provide their glasses or hearing aids if they can tolerate these. Delirious patients may experience hallucinations (often visual) or delusions, which are frequently paranoid. These may lead to agitation, fear, aggression or wandering. Severely delirious patients may need constant 1:1 observation (sitters), which may help avoid the use of physical restraints. These patients should never be left unattended.

Delirium in people with intellectual disability

Although the principles of management are the same as for the general population, people with diminished cognitive reserve, such as people with intellectual disability or the elderly, are more likely to develop a delirious state. In this population, delirium may also persist for days to weeks, even after any physical health problems have been addressed. This has important implications for care planning in this population.