11 Mar 2019
Up to 50 percent of people in aged residential care (ARC) in New Zealand will experience delirium and more than 50 percent of older people will experience it during a hospital stay. Defined as a rapid decline in brain function, delirium can affect anyone. It is not the same as dementia – delirium arises quickly and is usually reversible, whereas dementia develops over months and is mostly irreversible. Even a brief delirium increases the risk of poor recovery from illness, functional decline, permanent cognitive impairment, and other health complications such as pneumonia or falls.
World Delirium Awareness Day was created to inspire positive action among health care providers and the community to recognise, prevent and care for people with delirium. Held on 13 March 2019, it’s an opportunity for health care providers to assess their ability to recognise, treat and prevent delirium. In the South Island, a range of resources have been developed to support health professionals and aged residential care staff, as well as patients and their families.
Julian, Lois and Peter’s story
Cantabrian Julian Clothier understands first-hand what it’s like caring for a family member experiencing delirium. For two years, he was the primary carer for his wife’s ex-husband Peter, who was unable to look after himself due to ongoing health issues, which later resulted in delirium.
Peter had heart failure and a bypass earlier in life. A combination of complex medical conditions was ultimately the cause of his delirium. Although Peter was medically assessed to enter aged residential care at age 70, Julian and his wife Lois, a registered nurse at Canterbury DHB, decided to care for him themselves.
Peter’s delirium began in the last year of his life. Julian says it was incredibly challenging to deal with and would worsen at nights, where he would often revert back to his childhood and cry for his parents – but it also caused him to fight any attempts to help him.
Julian had always had a good relationship with Peter and says it was a real privilege to be trusted with his care, but he could not have done it without Lois and the support from the aged care team from The Princess Margaret Hospital and Nurse Maude Hospice. “They visited regularly and gave me advice and support whenever I needed it.”
Lois, who now has a personal perspective on a condition she has dealt with professionally as a nurse, says World Delirium Day is a great reminder for staff to review their systems, and the more information provided to families the better. “Many families wouldn’t know where to look for information to help guide them through the experience. Julian and I did a lot of research, but if you don’t have that professional health background, it can be very overwhelming. So I think the resources will be really helpful for families, friends and support people too.”
The South Island suite of delirium resources
The South Island Health of Older People Service Level Alliance (HOPSLA) has developed a suite of delirium resources for hospitals, aged residential care, for family, whanau, staff or people with delirium, which are available on the South Island Alliance website.
Val Fletcher, geriatrician and chair of HOPSLA, says the aim of the delirium toolkit and associated resources is to raise awareness about the importance of recognising delirium and what can be done to prevent and treat it in different environments. “The resources were designed to make it easier for staff to look at their own processes and systems, in terms of working towards recognising and treating delirium.”
The resources also help to educate patients and their families so they know what’s happening to them and what to expect. “Part of the focus of this work is to improve the quality of the care we are giving to patients and their families, by not only reducing the likelihood of their loved ones getting delirium and detecting it when it happens, but helping to support those who do get it, throughout the whole experience.”
Val says along with providing education, it’s also about changing systems, culture and environments to make them more delirium-friendly. “We want to introduce more systematic ways around monitoring delirium, including screening. We recommend the 4AT (a four-part test), which is a very quick questionnaire that is easy to deliver in most health care settings. It alerts the user that the patient either has definite delirium, possible delirium or some other cognitive impairment. Rather than providing a definite diagnosis, it pushes you in the right direction.”
World Delirium Awareness Day is on 13 March 2019. The South Island Alliance offers a simple toolkit and other resources for both inpatient care in public hospitals and aged residential care for both staff and families of people experiencing delirium. You can find them here: www.sialliance.health.nz