Why all the confusion? Dr Thomas Jackson @delirious_dr Clinical Scientist in Geriatric Medicine Honorary Consultant Geriatrician, QEHB Age Well 1/9/16

Do you understand the term ‘delirium’? Yes No

Experience of someone being ‘mithered’, ‘muddled’, ‘confused’ with a water infection? Yes No

Delirium So, I am here to talk to you about delirium – but why? Well, it is a condition that affects at least 1 in 5 older people in hospital, is a marker of not doing well in hospital, is often confused with dementia, is not dementia, but can be associated with dementia. Despite this we know very little about it, but it is both preventable and treatable. It is very often not recognised by health care staff and assumed to be ‘normal’ for older people It’s often confused with dementia, or assumed to be normal – what do you expect when old people get ill?

I’d like to show you this short video, produced by colleagues in the North East (so excuse the accents!) specifically for the public

Do you understand the term ‘delirium’? Yes No

Sudden change in mental function Usually associated with infection but lots of causes Quiet (Hypoactive) Noisy (Hyperactive) Anyone can get it, but fragile older people with brain diseases more at risk

Delirium

Delirium

Head injury

Mental change ‘confusion’ Brain inflammation + Brain failure Altered alertness Mental change ‘confusion’

http://www.prettyopinionated.com/2013/09/facts-about-utis-azo/

Chest infection + Inflammation

Cytokines - messengers Chest infection + Inflammation

Mental change ‘confusion’ Brain inflammation + Brain failure Altered alertness Mental change ‘confusion’ Chest infection + Inflammation

Ronnie’s problems started almost immediately after he came round from the one-hour operation in November 2011. His recollections are, thankfully, vague. ‘I woke up and the room was strange, all back to front,’ he says. ‘I don’t remember what happened or what I did – but apparently I did behave very badly.’ In fact, as Anne explains, he was found wandering the corridors of London’s private Princess Grace Hospital in his backless surgical gown. ‘Poor Ronnie didn’t know where he was,’ she recalls. ‘The nurses said it was probably a reaction to the anaesthetic and he was very confused. He ripped out all the various tubes attached to him, jumped out of bed, and ran off down the corridor. 18/1/2014 Daily Mail It was almost goodnight from me... after getting a new knee! Ronnie Corbett came close to death when he collapsed after having a joint replacement This illustrates the impact of delirium – it is distressing and casues worry for all involved. We also know that people who have delirium are more likely to not recover well from their illness and are at a higher risk of developing dementia Read more: http://www.dailymail.co.uk/health/article-2541730/It-goodnight-getting-new-knee-Ronnie-Corbett-came-close-death-collapsed-having-joint-replacement.html#ixzz4IqrsvOPG Follow us: @MailOnline on Twitter | DailyMail on Facebook

What happens to people with delirium Usually lasts 2-4 days with good recovery In some people it can persist for months Higher risk of not recovering as well Higher risk of developing memory problems such as dementia

How we treat it Recognise it – call it out Treat the underlying cause (s) Manage distress and keep safe

How we prevent it Recognise high risk situations Older people with dementia or frailty Significant illness, surgery, change in drugs Address simple things Keep hydrated Ensure meds reviewed (especially brain meds) Keep mobile, seeing and hearing Quiet environment, good sleep

Recognise high risk situations Older people with dementia or frailty Significant illness, surgery, change in drugs Address simple things Keep hydrated Ensure gets usual meds (especially brain meds) Keep mobile, seeing and hearing

What you can do Be aware – especially at times of high risk Advocate and communicate “This is not my Albert” “Its not normal” “Is it just a water infection?” Bring in glasses, hearing aids, pictures Monitor improvement

Delirium starts slowly, gets progressively worse, and cannot be reversed Yes? No?

Delirium is what you should expect when you are older Yes? No?

Delirium is preventable and treatable Yes? No?

European Delirium Association Websites Royal College of Psychiatrists Age UK Alzheimer’s society GP European Delirium Association