Delirium: A Guide for Families What is delirium? Delirium is confusion that comes on quickly over a matter of hours. It may affect one’s thinking, attention, and behavior. Delirium is a serious problem that will often get better. Sometimes delirium does not get better. People with delirium are not crazy, and delirium is not the same as dementia. What signs and symptoms may be present?   

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Trouble paying attention or concentrating Not knowing who or where one is A change in behavior: ○ Agitation (hitting or pushing, resisting care, or not cooperating) ○ Restlessness (feeling a need to move around or feeling tense and “stirred up”) ○ Lethargy (lack of energy), slowed speech and/or movements ○ Change in sleep (for example, may be more awake at night and asleep during the day) ○ Any other change in behavior or personality that is not normal for your loved one A change in perception: ○ Seeing or hearing things that others do not ○ Paranoid beliefs (thinking people are trying to hurt them) and not feeling safe A change in mood ○ Anxiety (being very nervous and fearful) ○ Depression (feeling sad or upset) ○ Anger Thoughts or words not making sense Mumbling or slurred speech

Note: Symptoms may change throughout the day. Your loved one may seem like his or her “normal self” at times. Risk Factors These health situations might increase the chance that delirium will happen:        

Being very sick Older age Dementia Dehydration (not having enough water in the body) Constipation (trouble pooping) Being unable to urinate (pee) or urinating small amounts Prior brain disease or damage Certain medicines

Updated 09/16/2014

Treatment of delirium Treatment involves fixing the medical issues that are causing the delirium and treating any troubling symptoms. Every person is different. Delirium might go away quickly or last for weeks. It might never go away. Let the care team know if you think your loved one has delirium. Tell the care team:  

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When you first saw a change in how your loved one acted or thought If something changed just before this new action or thinking started. For example, was a medicine added or taken away? Has there been a change in eating or drinking? Is there a new cough or problem swallowing? Did the patient just stop drinking alcohol? Were any treatments recently stopped or started? Was there a recent surgery or stay in the hospital? Any signs of delirium you have noticed (see signs of delirium on pages 1 and 2) Health problems your loved one has What medicines does your loved one take? Does the patient use a medicine “as needed”? How many doses have been taken? (example: pain, anxiety, or sleep medicine)

Help keep your loved one thinking clearly         

Arrange for friends and family to visit. Keep visitors to 1 or 2 people at a time. Keep sentences short and simple Use a calm voice Gently remind the patient where he or she is and what is going on Talk about current events and what is going on nearby Talk about childhood memories or favorite music Read out loud or using large print books Bring in a clock, calendar, and pictures from home; write the date on the whiteboard Avoid trying to correct false beliefs, perceptions, and unusual behaviors

Support healthy rest, sleep, and physical activity Decrease noise and distractions  Let in sunlight during the day, and keep the room dark at night  Keep lights low or off when resting  Help the patient sit in a chair, walk, and move around if it is safe. Please ask the health care team first. 

Support healthy eating and drinking 

If swallowing is not a problem and your loved one is hungry or thirsty, help the patient eat and drink. Please ask the health care team first.

Support good hearing and seeing Make sure hearing aids are working and are in place  Talk slowly and in a deeper tone of voice in the better ear  If the patient uses glasses, remind him or her to wear them  Use good lighting 

Delirio: Una Guía Para Familias ¿Que es Delirio? Delirio es confusión que puede suceder en unas cuantas horas. Puede afectar como uno piensa, su concentración, y su comportamiento. Delirio es grave pero muchas veces mejora. A veces el delirio no mejora. Pacientes con delirio no están locos, y el delirio no es lo mismo que demencia.

¿Qué signos y síntomas pueden estar presentes?  Dificultad prestando atención o concentrándose  No conocer quien es o en donde esta si mismo  Un cambio en comportamiento: Agitación (pegando o empujando, no cooperar con las enfermera/os) Inquietud (sentir la necesidad de moverse o sentirse tenso) Letargo (falta de energía), hablar o moverse lentamente Cambios en hábitos de dormir (por ejemplo estar despierto durante la noche y dormir durante el dia) ○ Cualquier cambio de comportamiento o personalidad fuera de lo normal para su ser querido  Un cambio en percepción: ○ Ver o escuchar cosas que otros no ven o escuchan ○ Paranoia (pensar que alguien les quiere hacer daño) y no sentirse seguro  Un cambio en el estado de animo: ○ Ansiedad (estar nervioso o sentir miedo) ○ Depresión (sentirse triste o trastornado) ○ Enojo  Pensamientos o palabras que no tienen razón ○ ○ ○ ○

 Murmurando o arrastrando sus palabras Los síntomas pueden cambiar durante el día. Su ser querido puede aparecer “normal” en ciertos momentos. Factores de Riesgo Estos factores pueden aumentar la posibilidad de desarrollar delirio:  Enfermedades graves

 Edad avanzada  Demencia  Deshidratación  Estreñimiento  Inhabilidad de orinar o orinando muy poco  Daño o enfermedad cerebral  Ciertas medicamentos

Modificada/Actualizada el 16 de Septiembre del 2014

Tratamiento del Delirio El tratamiento del delirio se enfoca en resolver los problemas médicos que están causando el delirio y tratar cualquier síntoma molestoso. Cada paciente es diferente. El delirio se puede resolver pronto o puede durar unas cuantas semanas. En unas ocasiones, el delirio puede ser permanente. Comuníquele al médico o equipo de cuidado si usted cree que su ser querido tiene delirio. Comunicarle al Equipo Medico:  Cuando notó por primera vez un cambio en la manera que su ser querido actuaba o pensaba.

 Si algo cambió antes de comenzar estas nuevas acciones o pensamientos. Por ejemplo, ¿Un medicamento fue empezado o discontinuado? ¿Algún cambio en lo que el paciente está comiendo o bebiendo? ¿Ha desarrollado una tos o problemas de tragar? ¿El paciente dejo de tomar alcohol recientemente? ¿Algún tratamiento que se haya empezado o discontinuado? ¿Hubo alguna cirugía recientemente o estadía en un hospital?  Algún signo de delirio que haya notado (ver signos de delirio en páginas 1 y 2).

 Problemas médicos o de salud que tenga su ser querido.  ¿Qué medicamentos toma su ser querido? ¿El paciente usa algún medicamento solo “cuando sea necesario”? ¿Cuantas pastillas se ha tomado? (ejemplo: medicamento para dolores, ansiedad, o para dormir). Como ayudar a que su ser querido piense claramente  Hacer arreglos para que amigos/as y familia visiten. Límite de uno o dos personas a la vez.

 Hable claramente con frases cortas y simples.  Use una voz calmada.  Recuérdele al paciente en donde esta y que es lo que esta pasando.  Hable acerca de acontecimientos actuales y de lo que pasa a su alrededor.  Platíquele de recuerdos de su infancia o de su música favorita.  Léale o tráigale libros con letras grande.  Ponga un reloj, calendario, y fotos en el cuarto. Escriba la fecha en el pizarrón (en el cuarto del hospital).  No trate de corregir los falsos pensamientos, percepciones erróneas, o comportamiento raro. Apoye el reposo, descanso, y actividad física  Disminuya el ruido y distracciones.

 Abra las persianas durante el día para dejar entrar la luz de día.  En la noche, apague las luces y trate de mantener el cuarto oscuro para que el paciente pueda descansar y dormir.  Ayude al paciente a sentarse en una silla, a caminar, y a moverse si es posible. Por favor pregúntele a alguien del equipo de cuidado de salud (médico o enfermera) primero. Apoye al paciente que coma y beba saludablemente  Si el paciente puede pasar saliva y comida sin problema, ayúdelo comer si tiene hambre o beber si tiene sed. Por favor pregúntele a alguien del equipo de cuidado de salud (médico o enfermera) primero. Apoye la vista y la audición  Asegúrese que los aparatos para escuchar (audífonos) estén funcionando y bien puestos.

 Hable despacio y en un tono profundo hacia el mejor oído.  Si el paciente usa lentes, recuérdele que los use.  Use buen iluminación.

Delirium Decision Management Tree: By: Michelle Weckmann 2014

The Post-Bereavement Phenomenology Inventory (PBPI) Instructions to patient: People who have experienced a recent, major loss react in a variety of ways. There are no "right" or "vvTong" responses to this questionnaire. After each numbered item, please check the sentence (either in the left or right column) that better describes how you have been feeling, thinking, or behaving for the past 1 to 2 months. Please check only one box for each numbered item: Which fits you better: The sentence on the left? Or ... I am tilled with despair nearly all 1. the time, and I almost always feel ness about the future.

2.

3.

4.

5.

6.

7.

My sadness or depressed mood is nearly constant, and it isn't improved by any positive events, activities or people.

The sentence on the right? I feel sadness a lot of the time, but I believe that eventually, things will get better.

n

My sadness or depressed mood usually comes in "waves" or "pangs," and there are events, activities or people who help me feel better.

D

n

D

D

n

n

n

D

D

D

When I am reminded of my loss (of a loved one, friend, job, etc.) I feel nothing but pain, bitterness, or bad memories.

I will probably never get back to feeling like my "old self' again.

I feel like a worthless person who has done mostly bad things in life, and let my friends family and loved ones down.

All I can think about lately is myself, and how miserable I feel; I hardly think about fi·iends, family or loved ones, except to blame myself for some failing. When friends or family call or visit, and try to cheer me up, I don't feel anything, or I may feel even worse.

When I am reminded of my loss (of a loved one, friend, job, etc.) I often feel intense grief or have painful memories; but sometimes, I have good thoughts and pleasant memories.

Things are really tough now, but I'm hopeful that, with time, I will feel more like my "old self."

I feel like I'm basically a good person and that in general, I have done my best for my friends, family and loved ones.

Even though I'm less social and outgoing since my loss, I still think a lot about friends, family and loved ones, often with good feelings about them.

When friends or family call or visit and try to cheer me up, I usually "perk up~' for a while and enjoy the social contact.

8.

9.

l

J

I often have persistent thoughts or impulses about ending my life, and I often think I'd be better off dead.

n Almost nothing that I used to like doing (reading, listening to music, sports, hobbies, etc.) is of any comfort or consolation to me oore.

10.

I feel "slowed down" inside, like my body and mind are stuck or frozen, and like time itself is standing still.

n

Source: Ronald W. Pies, MD; 2012.

l

J

I sometimes feel like a part of me has been lost, and I wish I could be re-united with the person or part of my life I am missing; but I n1ink.life is worth living. The things that I have always liked doing (reading, listening to music, sports, hobbies, etc.) give me some comfort and consolation, at least temporarily.

D

My concentration isn't as good as usual, but my body and mind aren't slowed down, and time passes in the usual way.

D

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