Monday, September 19, 2011

Delirium - we ignore it, or remain ignorant

One of my big complaints about my father's visit to the ER on the day of my mother's funeral - was not that he didn't receive great care. However, often the ER isn't always the place where adequate or accurate diagnoses are made. Especially for seniors with increasingly complex comorbidities.
Dad had delirium, which was masked by his dementia.
Family members must be aware. I could research the stats again, but it doesn't matter. Family members must be aware of delirium.
Staff must be trained in recognizing that dementia does not negate delirium.
Dad's untreated urinary tract infection, in a small, rural hospital, gave us as much grief as you can imagine, especially on the day of Mom's funeral. It was dangerous, too. He lit a fire in the wood stove in the wee hours of the night, I was sleeping in the bunkie at the time.
My brother missed Mom's funeral staying with Dad at the hospital all day.

We do more research in the area of health, and we ignore much of it, as well.

Dementia and delirium

Aside from the natural aging process, dementia and delirium in old age have many identifiable characteristics. Dementia is associated with, but not limited to, Alzheimer’s disease, vascular dementia, alcoholism, toxic reactions to medications (a huge risk in seniors), infections, metabolic disorders, malnutrition, and brain tumours (Pinel, 2006). Dad could have been suffering from any of these things, but no one was able to help us diagnose it. There is some confusion between delirium, dementia, and depression, and these require clarification, as well as early diagnosis by geriatricians. In The Hazards of Health Care (Heckman, 2004), warnings are given for undiagnosed dementia and delirium. The May 2008 issue of BP Blogger explains the difference between delirium and dementia. They say that it is the most common complication of hospital admission--between thirty and sixty-four percent in varying medical issues. One can have both delirium and dementia at the same time. Delirium is preventable and treatable; dementia is not.

Dementias, depression, delirium

These are terribly undiagnosed and life altering conditions for seniors. While dementia is a symptom caused by many conditions and cannot necessarily be ameliorated, the latter two are horribly under diagnosed since they are treatable.

Depression simply needs some excellent medical care. Seniors alone, and seniors in long-term care, are both susceptible. having volunteered with many seniors.

Delirium is a terrible response to medications, infections, metabolic disorders, drug interactions, drug overdoses, after surgery.

Dementia is an abnormal progressive deterioration of neural functioning. It involves:

• Memory impairment
• Diminishing intellectual ability; confusion; forgetfulness
• Poor judgment
• Difficulty with abstract thinking, e.g.,, math, time, thinking skills.
• Personality changes, e.g.,, stubbornness, agitation, poor or inappropriate social skills
• Sleep disturbances

Delirium can occur in response to stressors such as illness, surgery, drug overdoses, interactions of drugs, malnutrition (Cole, 2004) and can change daily. Between 32% and 67% of hospital patients are discharged with undiagnosed delirium (Rudolph and Marcantonio, 2003), and some 16% of seniors are readmitted to hospital (Forster, et al., 2004). It affects up to 50% of elderly hospital patients and can result in:

• Disturbance of consciousness
• Disorientation, wandering attention, confusion, hallucinations
• Increased LTC placements, infections, and increased mortality (Rudolph and Marcantonio, 2003)

A timely press release...

Delirium and adverse drug events can have a significant impact on a patient’s life. There is a wealth of research in improving the care of critically ill patients with delirium and on how to prevent adverse drug events. However, healthcare does not always reliably transfer evidence into practice and processes frequently fail despite the best intentions of a dedicated and highly skilled workforce. Our system, which intends to heal, often does just the opposite, leading to unintended harm for patients.
Participation in the Delirium and Medication Reconciliation Collaborative can contribute to the achievement of your delirium and medication reconciliation goals.
This Collaborative brings together teams that share a commitment to making significant and rapid changes to achieve results. It provides the structure, topic expertise and proven methods to create lasting improvement. Participants attend three learning sessions (two virtual sessions plus one face-to-face session) and are supported by expert faculty between sessions.

Click here for more information or to join a free Information Session on Tuesday, September 20 orWednesday, September 28.

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