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
Professor Young cited research data, drawn
mainly from the United States, showing that:
- 24 per cent of patients on general medical wards suffer
- 48 per cent of patients in critical care departments suffer
- 10 per cent of patients in accident and emergency departments
- 58 per cent of patients in trauma and orthopaedic departments
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
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.
“These patients need to be cherished,” Professor Young told
delegates. “They unravel very quickly if you don’t give them
appropriate care. With the new guidelines people will start
thinking, “Is this delirium?”. There needs to be an educational
approach which we hope the guidelines will stimulate – not just for
doctors, but care assistants in care homes. If they become more
knowledgeable about what delirium is they might recognise the
Professor Young urged the NHS to adopt delirium prevention
strategies “as a matter of urgency”, and reduce unnecessary
expenditure in the health service.
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International Congress of the Royal College of Psychiatrists, Edinburgh, 21-24 June 2010.