Delirium ‘invisible in the English health system’

Embargoed until 22 June 2010

Delirium (a state of mental confusion that can happen if a person becomes medically unwell) is the “elephant in the room” and is “invisible” in the English health care service, a leading geriatrician said this week.

Professor John Young, professor of Elderly Care Medicine at Leeds University and an honorary consultant geriatrician at Bradford Teaching Hospitals NHS Trust, told delegates at the 2010 International Congress of the Royal College of Psychiatrists that delirium was “a huge elephant” in general hospitals. ”It’s so big that you can’t even see it,” he said.

According to Professor Young, a patient with delirium is more likely to stay in hospital, more likely to catch hospital infections, more likely to develop dementia, and more likely to die.

Professor Young cited research data, drawn mainly from the United States, showing that:

• 24 per cent of patients on general medical wards suffer delirium
• 48 per cent of patients in critical care departments suffer delirium
• 10 per cent of patients in accident and emergency departments suffer delirium
• 58 per cent of patients in trauma and orthopaedic departments suffer delirium

However, when Professor Young asked the Department of Health for data showing the incidences of delirium in these departments in this country, the figures released were 0.26, 0.23, 0.15 and 0.06 per cent respectively. He said these figures bore little relation to clinical experience.

Professor Young told delegates at the Congress: “Delirium seems invisible in the English health service. Three quarters of the cases are missed. And they are missed because the change is so subtle. When someone comes into hospital having had a heart attack, it’s very obvious – it’s almost as if they have got it tattooed on their foreheads. But delirium is such a non-specific presentation, unless you’ve been trained about the subtlety of the condition, you just don’t think about it.”

Professor Young is chair of the National Institute for Health and Clinical Excellence (NICE) Guideline Development Group for Delirium, which is due to publish its guidelines on 28 July. The up-coming NICE guidance will have seven key recommendations and cover three main areas – awareness of the condition, identifying people at risk and strategies for preventing delirium.

The guidance will highlight groups that are particularly at risk, such as people over the age of 65, people who have had hip fractures, and people with brain damage. Once identified, a series of simple questions need to be asked to diagnose whether or not a patient has delirium.

Professor Young urged the NHS to adopt delirium prevention strategies “as a matter of urgency”, and reduce unnecessary expenditure in the health service.

References:

International Congress of the Royal College of Psychiatrists, Edinburgh, 21-24 June 2010.