Alasdair MacLullich

Some studies show that in some undergraduate degrees nurses get no formal #delirium training.

For an emergency that affects 1 in 6 hospital patients.

Help me understand why this is.

"In 2023, Alzheimer's and other dementias will cost the nation $345 billion. By 2050, these costs could rise to nearly $1 trillion."

— Alzheimer's Association

“The fever of my soul rendered every sight a maddening vision, and I was overtaken by a #delirium in which truth and nightmare danced as one.”

Edgar Allan Peo - The Black Cat, 1843

"The hate and anger that was coming out of him. I'd be quite honest, I was scared stiff." 

- Wife describing her husband's #delirium. 

Does your patient need you to provide reassurance?

Kindness goes a long way in #delirium.

Steps to better bone health.

#osteoporosis

Missed #delirium = longer stays, more complications, higher mortality, massive costs.

But hey, at least we saved 2 minutes by not doing a 4AT in the ED.

"The '4Ms' of an Age-Friendly Health System are What Matters, Medication, Mentation, and Mobility. These are a set of evidence-based practices that can improve care for older adults."

— American Geriatrics Society (AGS)

“Reality itself fragmented into a #delirium of shifting images, as if a fever had seized our senses and the world had become an unreliable mirage.”

Philip K Dick, Ubik (1969)

When speaking to person describing delusional beliefs, listen without interrupting or dismissing their experiences. Instead of immediately correcting them, say something calm and neutral like:

“That must be very frightening for you.”'

#delirium

Emergency Department (ED) staff: screen ALL patients over 65 for delirium.

Emergency departments are where it's most missed and most dangerous.

Make it as routine as checking blood pressure.

Health tips for older adults.

#medtwitter

Shocking reality: 1 in 4 older hospital patients develop #delirium, yet most families have never heard the word.

We need to do much better in improving public awareness of delirium.

"There is a critical shortage of nurses with specialized training in gerontology, which impacts the quality of care that older adults receive."

— National Hartford Center of Gerontological Nursing Excellence (NHCGNE)

"He saw visions of ships sailing through the air, and heard voices calling his name."

Notes from Underground, Dostoevsky

#delirium

Families: Caring for someone with #delirium is exhausting. Your wellbeing matters too. Take breaks, seek support, ask for help.

"Have you been having a difficult time?"

"Is there anything I can do to help you?"



➡️ Questions to help provide comfort to those with #delirium & #dementia

Useful infographic from the US National Institute on Aging.

#dementia #medtwitter

Delirium has a visibility problem, not just a diagnostic one.

How many cases of delirium are you missing day to day by not looking proactively?

"Care partners of people with dementia often feel isolated. A dementia-friendly community provides a network of support for care partners, connecting them with resources and other people who understand their experience."

— Dementia Friendly America

"I was in a fever, and everything seemed to be spinning around me."

Gitanjali (Poem), Rabindranath Tagore

#delirium

“Nobody used the word delirium. I thought I’d lost my mind.”

— Delirium survivor


➡️ Always provide clear information, including telling the patient they have delirium, during the episode. Then explain & de-brief afterwards.

Emergency Department (ED) staff: screen ALL patients over 65 for delirium.

Emergency departments are where it's most missed and most dangerous.

Make it as routine as checking blood pressure.

😞 Social isolation and loneliness in older people.

🇨🇦 From the Canadian Coalition for Seniors' Mental Health.

#DementiaCare #MedTwitter

Delirium develops over hours/days, dementia over months/years.

"Dad was fine yesterday, today he's a different person" = think delirium, not dementia progression.

"Providing person-centered care is essential for improving the quality of life for people with dementia. This involves tailoring care to the individual's unique needs, preferences, and values."

— National Council of Certified Dementia Practitioners (NCCDP)

"He saw visions of his ancestors, they were calling him, he could not understand."

Love in the Time of Cholera, Gabriel García Márquez

#delirium

“I needed to be told the date every time. Repetition ≠ patronising.”

#delirium

Does your patient need you to provide reassurance?

Kindness goes a long way in #delirium.

Factsheet - Frailty and deterioration


#frailty