Doha, 10 March 2020: In recognition of World Delirium Awareness Day, held this year on 11 March, Hamad Medical Corporation’s (HMC) Geriatric and Long-Term Care Department is leading a month-long campaign to inform and educate the general public, and healthcare professionals, about the common condition.
Dr. Anand Kartha, Senior Consultant, General Medicine, at HMC, said delirium is a sudden mental change or decline in brain function that is mostly caused by acute illnesses, injuries (such as a hip fracture), major surgery, or drug-adverse effects or withdrawal.
“Delirium is a life-threatening medical emergency and is an independent risk factor for increased mortality, morbidity, and healthcare expenditure. Delirium can result in increased lengths of hospitalization and long-term care requirements,” said Dr. Kartha.
According to Dr. Kartha, every 48 hours spent with delirium increases an individual’s mortality rate by 11%. He says, on average, one in five adult patients in hospital experiences delirium, with older patients, and especially those with dementia, at greatest risk. Dr. Kartha says it is important that healthcare providers, and the general public, can recognize the difference between delirium and dementia.
“Delirium represents a very rapid decline in brain function, which usually develops over hours or days. It is temporary, usually lasting a few days and is often reversible when identified and effectively managed. In comparison, dementia develops slowly, over months and years, and cannot be reversed,” added Dr. Kartha.
According to the International Federation of Delirium Societies, delirium occurs in up to 25% of medical inpatients, 50% of surgery patients, and 75% of intensive care patients. There are no approved medications for delirium; clinicians treat the condition by identifying and treating the underlying causes.
“Delirium is much more common than people realize and affects up to 40% of older hospitalized patients. It is a common post-operative complication, occurring in around 15% of elderly patients following general surgery. It is often poorly identified and managed because the diagnosis of delirium is complicated as it is often linked with other chronic conditions that may have overlapping symptoms,” said Professor Stephen Thomas, Chairman of Emergency Services at HMC.
Professor Thomas added the detection and prevention of delirium is a top priority for hospitals, and specifically for emergency physicians, as many patients will first present at Emergency Departments. He says delirium can easily be treated if detected early, underscoring the importance of ongoing delirium education for Emergency Department staff.
Dr. Ibrahim Mohamed Fawzy, Director of Critical Care at HMC, says delirium is also common in patients admitted to the ICU but notes it is frequently under-diagnosed and can negatively influence prognosis.
“Approximately two out of three patients contract delirium in the ICU setting and seven out of ten patients develop delirium while they are on a breathing machine or soon after,” said Dr. Fawzy, who is part of the recently formed National Delirium Steering Committee. The Committee is working to unify delirium care across medical and surgical units and in the ICU setting.
Dr. Nicola Ryley, Chief Nursing Officer at HMC says nurses are integral to preventing and identifying delirium, noting they play a vital role in assessing patients, identifying risk factors and symptoms, and implementing prevention strategies.
“Delirium can be prevented by optimization of physiology (e.g. avoiding dehydration), promoting orientation, rapid treatment of acute illness, correcting sensory impairments, and promoting natural sleep. Simple bedside nursing interventions can minimize the risk of delirium and enhance recovery in developed cases,” added Dr. Ryley.
Dr. Hanadi Al Hamad, Chairperson of Geriatrics and Long Term Care at HMC, and the National Health Strategy Lead for Healthy Aging, says delirium is complex and often multi-factorial and must be a global public health priority.
“Here in HMC, under the remit of the Ministry’s National Health Strategy 2018-2022, delirium care is given due priority and it is recognized that awareness is key to effective management. We have well-established awareness and training programs. During the last year we ran 55 education events and activities across Qatar, training 3,840 healthcare staff and raising awareness in upwards of 4,500 people in the community,” said Dr. Al Hamad.
“Delirium awareness is an ongoing priority for HMC and we will continue to work with colleagues in different disciplines and the public to help educate them about this issue so we can help reduce the number of cases, and through early intervention, decrease the risk of future complications,” added Dr. Al Hamad.