Doha, 31 March, 2019: On average, one in five adult patients will develop delirium while in hospital, with older adults being most at risk. Studies suggest as many as one in three elderly hospital patients will be affected by delirium.
Dr. Hanadi Al Hamad, Senior Consultant and Chairperson of Geriatrics and Long Term Care at Hamad Medical Corporation (HMC) says raising awareness about the warning signs of the common disorder was a key aim of World Delirium Awareness Day events held across HMC’s four general hospitals during March.
“Delirium is a clinical state of acute confusion due to rapid changes in brain function that occur with underlying medical conditions. It is usually triggered by a medical illness, and while more common among hospital patients, it can occur in the community setting. For elderly patients in hospital, delirium can be triggered by a combination of factors including infection, dehydration, poor nutrition, and certain medications such as pain killers. Delirium can also be triggered in hospital patients by surgery and anesthesia,” said Dr. Al Hamad.
Dr. Al Hamad, who is also the Ministry of Public Health’s National Health Strategy 2018-2022 Lead for Healthy Ageing, said delirium is complex and often multi-factorial. She says that educating frontline healthcare professionals so they are able to recognize the warning signs of the condition is essential as they play a major role in both preventing and detecting delirium, particularly in elderly patients.
“Delirium is a particularly significant problem for our elderly patients because a confused patient is at higher risk for falls and injuries. In the short-term, delirium can increase the length of hospital stays and can impact a patient’s ability to recover from their illness. In the longer-term, delirium has been linked to declines in independence and even an acceleration of cognitive decline,” added Dr. Al Hamad.
Dr. Al Hamad said delirium is thought to go unrecognized in nearly three out of four emergency care patients. She says her team is working hard to ensure healthcare providers understand that like any acute organ failure, delirium is a medical emergency and if untreated, can be fatal.
Dr. Mani Chandran, Senior Consultant Geriatric Psychiatrist, Department of Geriatric Medicine, Rumailah Hospital, said delirium often causes a variety of other cognitive and behavioral symptoms, such as memory problems, language problems, disorientation, and even vivid hallucinations. According to Dr. Chandran, family caregivers can be instrumental in recognizing the early warning signs of delirium.
“Families can be integral to detecting delirium because they are often the first to notice that their family member isn’t acting like their usual self. A key symptom of delirium is that the person develops difficulty focusing or paying attention,” said Dr. Chandran.
“Some elderly patients with delirium will appear agitated or restless while others will become quiet and withdrawn. In most cases, the symptoms fluctuate with the person appearing better at certain times and worse at other times. Symptoms of delirium can be difficult for healthcare teams to recognize as they will be unfamiliar with a patient’s normal behavior,” notes Dr. Chandran.
Dr. Chandran says both educating and empowering family members to spot the difference between delirium and dementia is also a priority for his department. He said many people confuse delirium and dementia because both conditions appear superficially similar.
“With our elderly patients, it is important to empower family members to immediately speak up if they notice any acute changes in their loved one’s behavior. Delirium and dementia can present very similarly, and this is further confused by the fact that people with dementia are prone to develop delirium because their brain is already vulnerable. Up to 60 percent of patients with delirium can have underlying dementia,” said Dr. Chandran.
He added if there is no pre-existing diagnosis of dementia in an elderly patient who presents with symptoms of delirium, a follow-up evaluation is essential after the acute symptoms are treated, including an assessment at the Memory Clinic.
HMC is working with the Ministry of Public Health and health sector partners across Qatar to develop a clinical practice guideline to improve delirium care in Qatar. The Department of Geriatric Medicine is also working on a population-based delirium study with the University College Hospital London that will help enhance understanding of the condition in Qatar, including the prevalence of delirium among the country’s elderly population.
