Top tips for optimising care for a person with delirium

What is delirium?

Delirium is a state of mental confusion that develops quickly and usually varies over the course of a day. ‘Delirium is a clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating in course’. The person with delirium has a reduced awareness and responsiveness to the environment, often leading to disorientation, incoherence, and memory disturbance. Symptoms of a delirium include hallucinations, delusions, and a dream-like state. Delirium can be present for several weeks after diagnosis and management, so be patient!  If the cause is identified and managed the delirium is likely to resolve.

Causes of delirium

There are a large number of possible causes of delirium. This can range from infection, urinary tract infection (UTI) chest infection, constipation, changes of medication or dose, overdose or side effects, alcohol  or illicit substance withdrawal and misuse,  dehydration, organ failure, epilepsy, effects of anaesthetic post-surgery, falls to name but a few.

Managing care

Treatment is based on the underlying cause of the delirium.  A short course of medication can be used if the person is in prolonged distress, or is at risk of harm to themselves or to others and verbal prompts are not working.

• Follow a consistent routine.
• Provide consistency in caregivers and limit the number of new people. 
• Use lighting to support day/night routine. 
• Reduce noise particularly at night or any loud activities which may increase anxiety.
• Blackout blinds will enable sleep and prevent early morning waking.
• Avoid moving the person through different environments unnecessarily.
• Have personal items with significance close by the person that they recognise and are comforted.
• Use clocks and calendars to help orientate them.
• During periods of alertness, engage them in meaningful activities for short periods of time.
• Ensure access to food, fluids and toileting needs are all supported.
•  Maintain use of dentures, glasses or hearing aids if required.

Communication

• Gain the person's attention prior to talking to them.
• Be aware of your body language; maintain eye contact and tone of voice should be soft in order to show you are fully listening.
• Slow down, and avoid asking multiple questions or commands that involves remembering something.
•  Set the scene; orientate person to the activity or intervention, breaking it down one step at a time.
•  Optimise their strengths using biographical history / ‘This is Me’, and support weaker areas of functioning.
• Be mindful not to highlight areas of deficit as this may result in increased agitation or aggression.
• Listen to the emotion, this may tell you more than the words themselves.
• Do not argue or confront, this can only make things worse.
• Confirm what they are saying or doing and provide reassurance and acknowledgement.
• Try using actions, pictures or objects if you are having difficulty communicating.