Acute Confusional State

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Acute Confusional State

• Aims
• Recognise the difference between chronic and
  acute confusion and explore the definition of
  confusion
• Explore the care and treatment of older adults
  with acute confusional states within an acute
  general hospital setting.

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Delirium in Older People

• Patients who develop delirium have high
  complication
• and mortality rates and longer lengths of stay in
  
• Hospital, (Young George 1999)
• Definition
• Delirium is characterised by disturbance of
• consciousness and a change in cognition
  developing
• over a short period of time.
• There is evidence that it is a direct consequence
  of a
• general medical condition, drug withdrawal or
• intoxication.

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Assessment Diagnosis

• A patient must show all the following features in
  order to make a diagnosis of delirium.
• Disturbance of consciousness, inability to focus
  or shift attention.
• Change in cognition or development of perceptual
  disturbance not accounted for by pre-existing
  dementia.
• The disturbance develops over a short period of
  time and tends to fluctuate during the day.
• Evidence that the condition is caused by direct
  physiological consequences of a general medical
  condition.

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Diagnostic feature of Dementia Acute Confusion

• Dementia
• Impairment in short term
• memory.
• Impairment in abstract
• thinking, judgement, cortical
• functioning and personality
• change.
• Deficits are not caused by
• delirium.
• History physical examination
• indicate deficits are produced by
• a dementia or cannot be
• Accounted by anything else.

• Delirium
• Disturbance of consciousness.
• Reduced ability to focus sustain
• or shift attention.
• Change in cognition and
• development of perceptual
• disturbance.
• Evidence from history, physical
• examination or laboratory
• findings shows presence of
• general medical condition.

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Common causes of Acute Confusion in Older People

• Infection
• Metabolic disorders
• Medications
• Multiple causes
• Dementia
• Anaesthesia
• Substance abuse and withdrawal
• Pain discomfort
• Constipation
• Risk Factors

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Key issues during and following Acute Confusion

• Who is this person and usual presentation?
• What is their usual level of functioning?
• Appropriate communication be with them.
• Older people their carers may need to talk
• about what has happened to them.
• Fear that this might lead to a mental illness.
• Patients may benefit from a follow up in the
• Community.
• The rehabilitation process may be delayed.

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Management of Confusion

• Good lighting, visible clues to orientation and
  sensory aids, (newspapers, calendars,
  photographs)
• Explanation of procedures short simple
  sentences.
• Avoidance of inter intra-ward transfers.
• Approaching and handling gently.
• Maintenance of normal sleep pattern, ensure fluid
  nutritional needs are met.
• Encouraging relatives and friends to help create
  a calming environment.
• Continuity of care by staff.
• (Young George 1999)

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Key Points to Remember !

• People with delirium often exhibit confused
• and muddled speech. It is preferable not to
• agree with confused communications, options
• could be
• Tactfully disagree.
• Change the subject.
• Acknowledge the feelings expressed whilst
• not confirming the confused perceptions or
• beliefs.
• Respect, Reassure, and Restore Calm