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Delirium among older people in hospital often untreated

  • 25 Comments

Acute confusion, which can triple the likelihood of death, is widespread among older people in hospitals and nursing homes but often goes untreated, according to new British and American research.

The condition - also known as delirium - is often undiagnosed, ignored or accepted as inevitable despite the fact it has an negative impact on people’s independence and mental processes, and significantly raises the risk of them developing dementia.

The research team, led by the Regenstrief Institute and Indiana University, reviewed 45 years of research covering almost 600 studies. The findings of the research, some of which was carried out at the University of East Anglia, is published in September’s issue of the Journal of Hospital Medicine.

With a third of delirium cases found to be preventable the researchers are calling for its early identification and treatment to improve people’s long-term prognosis.

The research showed more than 60% of delirium cases in general patient groups are not recognised or treated, with elderly patients leaving hospital in significant numbers with ongoing acute confusion that has been missed.

Among the measures that could prevent delirium were treating depression, getting rid of restraints, making sure patients have access to glasses and hearing aids and prescribing classes of antipsychotics that do not negatively affect the ageing brain, according to the research authors, who were led by Dr Babar Khan of the Regenstrief Institute and Indiana University School of Medicine.

A more sensitive screening tool for delirium, especially when used by a non-expert, were also needed, they said.

  • 25 Comments

Readers' comments (25)

  • It might be helpful for the ordinary non-medical person who has an interest in some condition or other that effects the brain (in my case it is someone in my family who had/has hyponatraemia), to lay out more carefully what exactly is meant by delirium here. A dictionary definition gives:

    ...state of excitement and mental confusion, often accompanied by hallucinations, caused by high fever, poisoning, brain injury, etc.

    It would be helpful to have medical conditions that are the cause of it (including hypotraemia) and whether the source of delirium is significant. The simplest version of this is where once a condition is stabilised, how does the delirium ameliorate, what sorts of stages does it go through as it does, if it does, so that a clinician can see from the detailed changes he is observing, that for example, a patient had delirium, but things are improving. Not everyone presents with a set of the full blown symptoms.
    As you hint in your article, docs tend to find a quick label for something and move on. I is too time consuming to spend time observing a patient. In my experience of my relative's illness, they just popped in a few times to do a quick checklist to work out whether there was confusion, level of cognitive capacities, but delve further in order to have at hand the detailed knowledge of what a person is and is not capable of, so that on release from hospital, and transfer to, say, a care or nursing home, the staff there have something to work on, rather than just a few words like confusion resolved, or some such.Tendency for intermittency being one of the most helpful things to know. As is true for all types of dementia.

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  • I tried to have my say.
    You apparently do not want to hear it!

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  • Recent research!
    If we have not learned by now? It is basic common sense and does not require expensive studies/research as an excuse to ascertain:-
    When older/visually impaired people are admitted to hospital it would help them tremendous if someone could ensure (dare I sat it) put a little bit of physical effort into giving them fluids/diet (do not believe the written word on these charts) There are many witnesses to what actually happens!

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  • Basically a UTI can cause delirium in elderly people, symptoms, confusion, aggression etc...

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  • Anonymous | 20-Sep-2012 3:59 pm

    Basically a UTI can cause delirium in elderly people, symptoms, confusion, aggression etc...



    I think you will find nurses who have done a few years to qualify actually know this already. any infections and fever as well as dehydration can cause delirium. it has multiple causative factors.

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  • should have read above 'a few years study to qualify ...'

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  • I must add that all the bed moves exacerbate this - goodness knows how much??

    Also, we 'save' patients or 'so-called prevent' illness on one hand, only to finish them off in another way. A good government ploy, thinking they pull the wool over our eyes. Am I the only person thet thinks this way?

    ... from an almost 40 year NHS veteran

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  • Anonymous | 20-Sep-2012 4:08 pm

    "I think you will find nurses who have done a few years to qualify actually know this already. any infections and fever as well as dehydration can cause delirium. it has multiple causative factors."

    That was rude

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  • Anonymous | 21-Sep-2012 8:35 am

    Anonymous | 20-Sep-2012 4:08 pm

    "I think you will find nurses who have done a few years to qualify actually know this already. any infections and fever as well as dehydration can cause delirium. it has multiple causative factors."

    "That was rude" !!!!!!!

    there is noting rude in restating the facts but i find it offensive to qualified nurses to underestimate their knowledge, besides the causes of delirium, as I said, are multifactorial.

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  • I believe that all nurses should have training in Dementia awareness. I know it is all common sense but in the hospital environment where there are critically ill patients on the same wards it is imperative that the nurses have the support needed to assist these patients.

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