A Guide for Relatives and Carers
What is delirium?
Delirium is a common complication of acute illness. 20% of all patients in hospital develop delirium. A patient who is delirious is often experiencing a world which makes no sense to us, but is very real to them. For instance they may:
- Not know they are in hospital
- Think they can see frightening animals
- Think they have been kidnapped
- Think staff are pretending to be nurses
- Try to make sense of the noises around them by creating a different explanation e.g. they make think someone is being tortured when in fact it is simply another patient feeling upset
The patient is convinced about the reality of the confused world they are in. It can be terrifying for them and worrying for relatives.
Often a patient who is delirious will still recognise family and friends although they will not generally believe their reassurances. They will usually want to get out of bed and go home. Patients with delirium can also find it very difficult to understand information and they may forget what you tell them. Delirium can also change quickly, one minute you can be having an ordinary conversation – and the next minute they will say something that makes no sense.
Who gets delirium?
Anyone can get delirium if their illness is serious enough. Older frail patients, those with dementia and patients with poor hearing or eyesight are more likely to develop delirium. Common medical causes:
- Infection
- Medications
- Surgery
- Pain
- Constipation
- Falls
- Malnutrition and dehydration
How long does delirium last?
It is usually temporary – a few days to a week. Sometimes, it can last longer and may take several weeks to completely clear. Even once the patient is no longer delirious, it may take some time for them to work out what really happened to them and what was imaginary.
Does it have lasting effects?
Delirium is a serious event which we expect to get better as patients recover. You may notice a change in your relative’s memory once you get home, or they may find it difficult to remember the words for things. This should get better over time, but if not it would be good to speak to their GP about this.
What can you do to help?
- Please visit if you can
- Speak slowly
- Speak in short sentences
- Please try to remind them of the day, date and time
- Tell them regularly that they are in hospital
- Provide familiar objects e.g. clothes, toiletries and photos of family and friends
- Help the ward staff to understand the patient and what they would like
- Avoid contradicting them if they are distressed
- Help to establish a day/night routine to help normal sleep
- Encourage them to stay mobile – even just sitting in a chair rather than staying in bed
- Encourage them to eat, drink and take their tablets
- As they recover they may recall distressing thoughts – reassure them that they had delirium and that they are getting better
What will staff do to help?
- The team will identify and treat underlying causes of delirium
- We will create a calm, well-lit environment free from loud noises
- You will be provided reassurance from the team if you are distressed
Moving on – When the patient recovers…
You may find that your relative has little memory of what happened to them in hospital and they may find this distressing. It may help them if you can fill in the gaps in their memory by gently explaining the events in the course of their hospital admission.
You may also find that your relative remembers things incorrectly therefore it might be helpful for them to revisit the area of the hospital they were in. This can be arranged by contacting the ward directly.
If your relative has questions about their hospital admission that you cannot answer please write these questions down and take them with you to any follow up appointments.
If you would like to meet people who have had similar experiences to yourselves, especially related to delirium in the Critical Care Department there is a local support group called ICUsteps Gateshead. For more information about this group see www.icusteps.org/support/gateshead
This groups meets between 2pm & 4pm on the last Thursday of every month at Sheriff Hill Methodist Church – you’d be very welcome to pop in.
For more information telephone the critical care rehabilitation team on 0191 4453210.