Howastay inhospital cantipyou overtheedge
Thousands develop a condition called delirium which can lead to terrifying hallucinations and even long-term harm
GOING to visit his 91-year-old grandfather Bill in hospital, Chris Rossiter was expect-ing to share a few jokes with the energetic man he describes as a ‘big, friendly giant’. After all, Bill had only been admitted following a fall and the family thought he’d soon be on the mend. yet once Chris got there, the man he saw in the hospital bed was unrecognisable.
‘He looked so terrible — more like Gollum in the Hobbit,’ says Chris, 35, the director of a youth literacy charity.
‘I could see his mouth was moving, and as I got closer to the bed I could hear he was repeating: “I just want to go home, I just want to go home.”
‘my first reaction was to think he was being mistreated, but then he started telling us the most incredible stories about what was going on in the hospital.’
According to Bill, a retired factory worker from Basildon, essex, the busy ward was a scene of carnage: there was rioting, scream-ing, windows were being smashed and the man in the opposite bed had apparently been stabbed with a screwdriver.
‘It was such a weird experience and something I’d never come across even though I’m a trained psychologist,’ says Chris. ‘He’d gone from being my grandfather to this deranged being who bore no resemblance to him.’
yet when Chris went back to see Bill a few days later, he was ‘absolutely fine’.
Bill was suffering from delirium — a state of severe confusion, which can last for hours, days or even weeks. It affects at least one in five elderly people admitted to hospital.
Recognising the symptoms means patients receive the care they need and can be the difference between going home or a prolonged hospital stay and distressing loss of independence.
However, surveys show low awareness of the condition among medical pro-fessionals and the public.
‘Sometimes it needs a period of observation before you can be sure and it requires information from people who know the patient well,’ says Dr Sarah Pendlebury, a neuroscientist at the University of Oxford and a doctor at John S Radcliffe Hospital. SYMPTOMS can overlap with underlying conditions the patient may have, such as dementia. ‘there’s still a lot of feeling that it’s just “Granny having one of her funny turns,”’ says Dr terry Quinn, a clinical senior lecturer specialising in geriatric medicine at the University of Glasgow. ‘But delirium can be a warning sign of a more serious medical problem.
‘the patient’s confusion high-lights that something else is going on, such as an infection. Doctors need to see what’s causing it then treat the underlying disease.’
there are two types of delirium — agitated and sleepy, says Dr Pendlebury. ‘In the first case, patients become more confused and quite agitated. they may have a lack of attention, so when you’re speaking to them they can’t focus and are easily distracted by the environment around them.
‘they might be picking at drips, pulling at bedclothes or interfer-ing with things around the ward.’
By contrast, in the sleepy form, which is more common, ‘patients will often just be less active than usual’, making it even more difficult to spot.
‘they can be a bit withdrawn — a bit like someone might be if they have depression — and may not want to get out of bed or interact with staff.’
Delirium is triggered by stress to the body — usually the result of an infection or injury. For older people, especially those who have dementia or other problems with memory, something as seemingly innocuous as a urinary tract infection, a change in medication or even constipation can trigger an episode.
One theory is that molecules produced by the immune system get into the brain and affect its function, causing hallucinations, uncharacteristic behaviour and extreme confusion.
DELIRIUM can also be triggered by a major hit to the body’s repair mechanisms, such as a life-threatening infection, surgery or spell in intensive care.
Changes in the environment — the unfamiliar setting of a busy hospital — also contribute.
‘If you were to design an environ-ment that caused delirium it would be a contemporary hospital,’ says Dr Quinn.
‘It’s hard to get a good night’s sleep. Wards are incredibly noisy, even at night with alarms going off, and you might be woken very early when you’re not used to it.’
Not only is delirium more common in people with dementia, it can hasten the onset of memory problems in elderly people who have previously been well.
A recent study at University College london and the University of Cambridge found people who suffered an episode of delirium were eight times more likely to be diagnosed with dementia within the following three years than people who had not.
In addition, people with existing dementia had a three-fold risk of the condition worsening after suffering delirium.
there is no effective treatment for delirium. However, there are steps that can help to calm the confusion. ‘Hydration and nutrition are important, as is making sure the patient is not in pain,’ says Dr Pendlebury.
‘We also know sensory depriva-tion tends to make delirium worse. If people can’t see or hear what’s going on properly, they’re more likely to get confused.
‘It’s vital to make sure patients have their glasses or hearing aids, and that they are switched on and working.
‘We give a short thinking and memory test: ten simple questions that can determine whether or not someone has a cognitive problem,’ she says.
‘that, coupled with information from family, helps staff to say whether it’s a definite case of delirium or it’s uncertain and we need to observe the patient over the next day or two.’
the bigger question is whether hospital is the best place to take people at all.
At the Nuffield department for public health in Oxford, Professor Sasha Shepperd is running the Hospital At Home study, the largest clinical trial comparing hospital admission for frail elderly patients with specialist care delivered at home.
more than 1,300 patients are being recruited across the UK in the hope of finding out whether keeping this group out of hospital cuts the chances of delirium and improves long-term outcomes.
For now, there are several things that relatives and carers should look out for.
‘If their elderly relative has been unwell and are acting unusually, that could be the sign of delirium,’ says Dr Quinn. ‘Don’t write it off as a funny turn — it needs medical assessment. Delirium isn’t some-thing to fear or a sign you’re going mad, it’s a physical illness that can be treated.’
Bill’s delirium disappeared within days after doctors found and treated an urinary tract infection. ‘His character returned and he was laughing again,’ says Chris.
there have been episodes since then, but his family are better equipped to spot the signs.
‘It’s a bizarre experience to see someone in a state that is so extreme, but to rebound from it seems incredible,’ says Chris.