00:01
So what is delirium?
Delirium is an acute
change in brain function.
00:05
It's usually demonstrated by
a rapid onset of confusion,
emotional instability,
altered level of consciousness,
cognitive changes,
and also disorientation.
00:20
And it is really important that
we keep delirium as an emergency,
a medical emergency.
It needs help right away.
00:31
When we think about it
as a medical emergency,
we want to understand that
there is an increased mortality rate
of two to 20 times higher
than with other patients.
00:44
Part of this is because
we don't know
why these acute changes
are occurring.
00:50
We don't know whether this person
mixed medications,
and suddenly those medications
have become toxic
to the person's brain.
00:59
We want to make sure
that this delirium,
this fast onset of cognitive changes
is taken very seriously.
01:09
And that we absolutely
take the steps
in order to find out
what's causing it,
and how to stop it?
And to provide
any life support that is required.
01:21
Statistics for delirium
in older adults,
is that maybe 1 to 2%
of the population
who are 65 years or younger,
will have delirium.
01:37
And as a person gets older,
then that increases
their likelihood and possibility,
and the prevalence of delirium.
01:47
So by the time a person is 85,
we see that 10 to 14%
of the population
may be experiencing delirium.
01:57
Now, substance use,
withdrawal from substance use,
this also can cause delirium,
as kind of reaction to
the polypharmacy.
02:08
So many of our older adults
are on multiple medications.
02:12
And sometimes
the different specialists
are not communicating
with each other.
02:17
So we want to be aware of that.
02:19
The other thing is,
if you have an older adult
who is somewhat confused,
who's on multi medications,
they might get mixed up
and take the wrong medications.
02:30
So these are all things
that the nurse
is going to keep in mind
as we see somebody
who may be presenting
with the signs and symptoms
of delirium.
02:42
So the onset of delirium
has a cardinal sign.
02:47
And if you have heard me say, once,
or three, or four times already,
in this presentation,
this rapid onset should
really be a red flag for us.
03:00
The change that the person
is going to be having
in their level of consciousness,
we will see that because perhaps,
their thoughts or even their speech
become incoherent.
03:13
They have a level of restlessness
that brings our attention to them.
03:19
They're confused.
They don't know where they are.
03:22
They don't know what's going on.
03:25
They may be having some
illusions, alright.
03:28
And illusions are different
from delusions.
03:32
Your delusions are those thoughts
that have no reality.
03:36
Illusions are something that looks
like something else to them.
03:41
For example,
maybe you go to start an IV,
and they see the tubing
and they think it's a snake.
03:48
That would be an illusion.
03:50
But they also with delirium
might be having hallucinations.
03:55
And hallucinations are
actual, visual,
or other perceptual understanding
of something going on,
that isn't actually happening
in the environment.
04:10
So you could have a
visual hallucination,
auditory hallucination,
olfactory hallucination,
tactile hallucination,
any sense, can be affected.
04:21
Hallucination is originating
from a brain
that is not functioning properly.
04:29
And so it is really important
if a person tells you
that they see or hear someone
that you ask them.
04:37
What is the person saying to you?
To make sure that that hallucination
is not a command hallucination.
04:46
Now, did Jai have any
of these cardinal signs?
Let's think back to Jai.
04:53
Well, he had the incoherent
speech and thoughts.
04:59
He also had the confusion.
He had that restlessness.
05:05
He had hallucinations.
05:08
I don't believe
he had the illusions,
but he had the rapid onset.
05:13
So we should have a red flag
up now to take care of Jai.
05:19
Some of the other signs of
delirium are hyperactivity,
which comes from that
restlessness, right?
That confusion.
05:27
If you can put yourself
in the body of a person
who not quite sure
what's going on,
and all of a sudden the world
looks different to them.
05:36
They may have hyperactivity,
they may have some
psychotic symptoms,
like those hallucinations.
05:43
They might have
psychomotor agitation.
05:47
So when we also want to be safe,
they might actually be
moving in such a way
that we want to make sure
we give them
the distance that they need,
so that we don't become injured
when taking care of someone.
06:02
We also want to know that they
may have these verbal outbursts.
06:07
It's not about us,
it is about their confusion.
06:10
And so they might shout.
06:12
It might be that they are hearing
something that we're not hearing,
that they have voices that are
occurring from internal stimuli,
not from external.
06:21
And you want to be able
to understand
that those verbal outbursts
are not about you.
06:27
It is about this delirium.
06:29
It is a sign that we must
take very seriously.
06:33
Also, they may have some
purposeless behaviors,
rolling of the fingers,
or tapping of the fingers,
or straightening out the sheets,
but repetitive over and over again,
without any purpose to them at all.
06:54
So as soon as we know
that the delirium is happening,
number one,
it's a medical emergency.
07:00
And then we look at
what is causing the symptoms.
07:04
So we have to take a good history,
we would sit down,
we would try and find out
from the partner what is going on,
and we would treat it
as this medical emergency.
07:16
In this way, we would make sure
that we have an airway present,
so that in the event
that the person's airway,
somehow it becomes
not working correctly,
that we are able to make sure that
we keep a clear airway for them.
07:32
We have to treat the symptoms,
as soon as we make a diagnosis.
07:37
And if the person is having
hallucinations,
they may actually have an
order for some anti-psychotics
to be used in the short-term
to relieve those symptoms.
07:52
We also need to know that there
might be a need for sedation.
07:58
So if the practitioner
is ordering sedation,
or anti-psychotic medications,
that is to treat the
symptoms of delirium.
08:08
Finally, we need to be
monitoring very closely,
this level of consciousness.
08:14
Is the person aware of
time, place, and person?
Is a person sleepy?
Is the person awake?
If the person is going from an
awake state to a very sleepy state,
this is one of those cardinal signs
that we have to be ready
to maintain that person's airway.
08:35
So, let's think about the difference
between delirium and dementia.
08:40
When we think about delirium,
we know that it is a
disturbance in consciousness.
08:46
It is a change
in the person's cognition.
08:50
It develops very quickly.
08:53
And you know,
over a short period of time.
08:56
We also know that it's common
with hospital patients,
especially in older adults.
09:05
We call it like,
they may be suddenly
not able to get
to where they have to go.
09:13
They may forget things.
09:15
They may become delirious
after being hospitalized.
09:21
It's always secondary
to another physiological condition.
09:26
Delirium is telling us
something else is going on here.
09:30
And it's asking,
it's pleading for us
to do our due diligence
and find out
what has gone on
that has disrupted the brain
in this abrupt and acute way?
It is transient.
Delirium is not a long-term thing.
09:48
Delirium is that red flag
that's going to pop up,
something has gone
terribly wrong in the brain.
09:55
And let's find out what it is.
09:58
And it is usually an
underlying condition.
10:02
And so once we fix, and treat
that underlying condition,
there should be recovery
from delirium.
10:13
Now, how does that differentiate
from dementia?
Dementia is not rapid onset.
10:18
It is a progressive deterioration
of cognitive functioning,
and global impairment of intellect.
10:26
So the person
is losing their capacity
of thinking of memory.
It is ongoing and progressive.
10:37
We don't usually see a
change in consciousness.
10:40
With delirium,
we're seeing
this consciousness go
from alert to sleepy
to perhaps comatose.
10:48
Whereas, in dementia, we're not
seeing any change in consciousness.
10:53
We will see a
difficulty with memory,
a difficulty with thinking, and also
with comprehension in dementia.
11:03
We see that also with delirium.
11:06
Now, unlike delirium,
which is reversible,
dementia usually
is not reversible.
11:15
It is chronic and
it is progressive.