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Two thirds of NHS beds are occupied by people aged 65 yrs and over.

Two thirds of NHS beds are occupied by people aged 65 yrs and over. 60% of general hospital admissions in this age group will have, or develop a mental disorder during their stay. (Lets Respect 2006). The 3 D’s Dementia, Delirium, Depression.

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Two thirds of NHS beds are occupied by people aged 65 yrs and over.

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  1. Two thirds of NHS beds are occupied by people aged 65 yrs and over. • 60% of general hospital admissions in this age group will have, or develop a mental disorder during their stay. (Lets Respect 2006)

  2. The 3 D’s Dementia, Delirium, Depression • Delirium - A sudden, temporary state of mental confusion and fluctuating consciousness resulting from high fever, intoxication, shock, or other causes. It is characterized by anxiety, disorientation, hallucinations, delusions, and incoherent speech.

  3. Causes of Delirium • Poorly controlled diabetes • Liver Problems • Kidney Problems • Vitamin Deficiency • Thyroid problems • Trauma – head injury • Epilepsy • Cancer • Infection • Prescribed medication • Toxicity • Alcohol intoxication and/or withdrawal • Heart circulation/problems • Metabolic – hypoxia, electrolyte imbalance • Dehydration • Trauma, shock, pain, • Operations • Poorly controlled diabetes

  4. MOST COMMON REASONS • INFECTION • CONSTIPATION • CHANGE OF ENVIRONMENT/ROUTINE

  5. Other features of Delirium • Altered Perception - visual hallucinations and illusions • Disturbed behaviour – always search for the meaning • Restlessness – especially at night – trying to make sense of things • Agitation and fear • Shouting and the possibility of aggression AVOIDABLE IN MANY CASES LACK OF AWARENESS LEADS TO HIGH MORTALITY AND MORBIDITY

  6. Reversibility • If you can treat the reason for delirium the confusion will clear • N.B. confusion is not progressive unless the cause is progressive. • Acute confusion is therefore a medical problem requiring rapid and accurate diagnosis with treatment of the cause being a matter of urgency with the hope of recovery

  7. Depression: Persistent sadness/low mood Loss of interest/pleasure Fatigue or low energy Change in appetite – weight loss Change in sleep pattern

  8. Poor concentration • Feelings of guilt / worthlessness • Exaggerated beliefs • Suicidal ideas • Agitation

  9. REMEMBER THE 3 D’S-Delirium, Dementia and Depression

  10. ‘Challenging Behaviour’ • Pain is positively associated with screaming, aggression and verbal agitation in dementia. (Cohen-Mansfield et al., 1990) • Primary response to ‘challenging behaviours’ is treatment with anti-psychotic medication (Balfour and O’Rourke, 2003; Elenchenny, 2001) • This could mask symptoms related to pain and its treatment (Kovach et al., 1999)

  11. ‘Challenging Behaviour’ • Growing evidence that use and type of medication is related to staff attitudes and practices and less to the diagnosis of dementia and associated symptoms and behaviours (Jones et al 2004; Wills et al. 1997 ) • ‘There is a link between staffing levels and a high level of sedative medication’ (Carlisle 1997)

  12. The Consequence • People with dementia are prescribed and given less analgesia than other older people(Horgas and Tsai 1998) • Even when analgesia is prescribed to a person with dementia 83% did not receive their medication(Dawson 1998) • 76% of people with dementia did not receive regular analgesia post operative hip repair, despite 42% expected to be in severe pain (Morrison and Sui 2000)

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