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Delirium, an acute confusional state, can compound the confusion and exacerbate behaviours caused by dementia.

Delirium has numerous causes, with a wide range of risk factors which are detailed here. People with multiple risk factors are more likely to suffer from delirium. Treating the delirium is critical as it presents a significant health risk and can limit the effectiveness of any behaviour management strategies. Follow this delirium screen flow-chart to identify whether delirium is contributing to the behaviour changes.

Consider the use of this pathway if the person is aged over 65 years or 45 years for Aboriginal or Torres Strait Island Communitities.

For further information on delirium, please read Delirium Care Pathways (Traynor & Britten, 2010)

Delirium risk factors:

  • Infection
  • Pain
  • Dehydration
  • Multiple medications
  • Malnutrition
  • Electrolyte dysfunction
  • Sensory impairment
  • Hepatic or renal dysfunction
  • Sleep deprivation
  • Cardiovascular Disease
  • Immobility
  • Constipation/Diarrhoea
  • Depression
  • Indwelling catheter
  • Physical restrain
  • Abnormal sodium
  • Hospitalisation
  • History of delirium

 

Interactive delirium screening tool

Has the patient/client been identified as potentially suffering from delirium?

1. Conduct baseline cognitive function assessments

  • Is the person’s cognition currently impaired?

2. Determine any changes in cognitive function

  • Has this change occurred over hours or days?
  • Does the person’s presentation fluctuate over the day?

Differential diagnosis

  • Assess for depression or dementia
  • Assess & manage risk factors
  • Screen cognitive function at regular intervals

3. Assess for Delirium

  • Confusion Assessment Method (CAM)
  • MMSE/Heidelberg Cognitive Screen/Clockface/RUDAS
  • Medication review: Any changes in the past weeks or months?
  • Organic Screen: CBE, biochemistry, U/E/C, LFT, TFT, urine, C&S, chest x-ray
  • Physical examination and pain review

Is there a confirmed diagnosis of delirium?

4. Consider sub-clinical delirium

  • Does the patient/client have some symptons of delirium?

Adapt Care Plan

  • Refer to GP or specialist for treatment
  • Provide supportive care
  • Refer to Delirium Care Pathways (Traynor & Britten, 2010)

5. Monitor and respond to any sudden changes in cognitive functioning by repeating pathway.

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