WHAT would you do if someone close to you suddenly became confused, agitated and not at all like their usual self?
It’s a surprisingly common occurrence, especially among older people, and has the medical name of “delirium”. One in eight hospital patients is affected by delirium, which can make people unsteady on their feet with a greater risk of falls, increases the risk of developing dementia if left untreated, and can result in longer hospital stays or admission to a care home.
As with most medical conditions, early diagnosis and prompt treatment usually leads to a better long-term outcome, so it’s vital to recognise early if someone close to you is becoming confused and possibly suffering from delirium. Don’t assume it’s an inevitable part of getting old, or put it down to someone ‘having an off-day’. Getting medical help early could make a big difference.
There are several ways to spot if someone is becoming confused. They might not be able to think or speak clearly or quickly; they might not know where they are and feel disorientated; they might struggle to pay attention or remember things that happened only recently, or they might appear to see or hear things that aren’t really there (hallucinations). All these things can be signs of delirium and should start to ring alarm bells that the person affected needs medical help.
If you want to check, try asking the person apparently simple things like their name, how old they are, or what the date is today? If they seem unsure or can’t answer as easily as they normally would, it’s time to get medical help. If the symptoms seem mild, have developed slowly over a period of time, or only happen now and again, the person should see their own GP as soon as possible.
However, if someone becomes suddenly confused, perhaps for the first time and is displaying symptoms that are markedly different from their normal self, you should seek help immediately by dialling 999 for an ambulance or going straight to your local hospital A&E department. Many of the causes of sudden and pronounced confusion need assessment and treatment as soon as possible. In some cases, the cause could be life-threatening.
If you call an ambulance, stay with the person until it arrives. Use simple words and short sentences to tell them who you are, where they are and to generally reassure them. If possible, make a note of any medicines they’re taking to pass to the paramedics. Avoid asking the person lots of questions while they’re confused – it could make them more agitated. Also, don’t try to stop them moving around if they want to, unless it poses a danger.
There are several causes of delirium (sudden confusion), some less serious and easier to treat than others. Some of the causes include:
- an infection – urinary tract infections (UTIs) are a common cause of delirium in elderly people or those already living with some form of dementia
- a stroke or ‘Transient Ischaemic Attack’, known as a TIA or ‘mini-stroke’
- a low blood sugar level in people with diabetes
- side-effects of some prescription medicines, especially if taken for the first time
- a head injury, even if it isn’t an obvious one
- carbon monoxide poisoning, especially if the delirium affects more than one person sharing the same living space
- a severe asthma attack of other problems with the lungs or heart
- alcohol poisoning or alcohol withdrawal. For withdrawal, the confusion might be accompanied by other symptoms including shaking, shivering and a cold sweat (known as ‘delirium tremens’ or ‘DTs’).
A new pilot scheme developed by the Salford Royal NHS Foundation Trust is now being rolled out across England to detect delirium in patients over 65 on admission to hospital for any reason. The scheme has increased the number of people correctly diagnosed with delirium by more than a third (34%) through the introduction of a new, standardised and more thorough screening process. Doctors and nurses run through a symptoms checklist on a mobile computer or handheld device.
Once delirium is detected, further checks and tests are carried out to diagnose the cause and determine the best course of treatment. It means the length of stay in hospital for these patients has been cut by 11%, saving an estimated £1.7m in the first year of the trial and also cutting the number of readmissions for delirium. These benefits for patients and cost savings for the NHS should be amplified greatly when the Salford pilot is rolled out across England.