Why is it important to know about delirium?

Although older people in any setting can develop delirium, it is mostly studied and described in hospital patients. It is suggested that in general hospitals 20% of older patients (range 7–61%) will develop delirium and in patients who undergo surgery for fractured neck of femur 10%-50% of patients will go on to develop delirium. The consequences of a patient developing delirium are known to be serious. It can interfere with the individual’s understanding of their treatment and therapy and their ability to participate, resulting in a slower rate of recovery and prolonged time in hospital (3). As most nurses are only too well aware delirium is associated with unwanted consequences such as falls, fractures, the development of pressure ulcers, and patients pulling at or removing their own bladder catheters and drainage tubes. Nurses also know that it can interfere with nutrition, hydration and the administration of medicines. Patients who develop delirium are more at risk of dying and a hospital patient is more likely to be discharged to a care home (3).

Although full recovery is a potential outcome for delirium, factors such as age, severity of illness, underlying cause, appropriateness, effectiveness and timeliness of treatment and support have a bearing on this. It is usual for a patient to recover from delirium within a week but delirious episodes may recur for several weeks, or months especially at night (3). Delirium is therefore, a serious threat to the continuing independence of older people and early detection and appropriate treatment have been shown to improve outcomes for both older people with delirium and people with dementia who develop delirium.

3. Faculty of Old Age Psychiatry. 2005. Who Cares Wins. Royal College of Psychiatrists, London