Editorial made simple – 8th March, 2018

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UNDERSTANDING THE DELIRIUM

Delirium, or an acute state of confusion, occurs commonly in the elderly, usually due to underlying physical illnesses or disorders, and is linked to caregiver distress and hospitalisation.
• It occurs in 20-40% of patients in the hospital intensive care unit and is much more common in mechanically ventilated patients.
• Age is a risk factor for developing this condition, which is detected by careful assessment.
• The persons’ behaviour becoming more unresponsive and unmanageable with the setting sun, a phenomenon known as the “sun downing” effect.
• The elderly may also experience perceptual abnormalities such as visual or auditory hallucinations.

Common causes:

• urinary tract (UTI) or chest infections (which can be detected and treated early)
• Delirium could be linked to abnormally low levels of sodium.
• Chronic alcohol abusers may face withdrawal symptoms upon sudden discontinuation of the substance, and this can lead to a condition called delirium tremens.

Management of delirium:

The management could be through avoiding bright light or darkness, noise, excessive stimulation, ensuring adequate food and fluid intake, ensuring regular bowel and bladder habits and the sleep-wake cycle.
Repeated reorientation is needed, making the caregiver’s role important. The risk of falls is high and it will be necessary to plan for regular pulse and blood pressure monitoring.
More broadly, promoting understanding of and awareness about this condition among the family, friends and carers of the elderly can lead to much more reassurance, particularly where the cause is a minor infection