Tackling delirium through the simple things in life
A blog post written by Dr. Annmarie Hosie
Delirium – an acute decline in thinking related to illness, injury or medical treatment - is serious, distressing and common for people with advanced illness, especially in hospital. The affected person can have great difficulty dealing with the confusion, fear, anger, and sense of shame, and in communicating with others, trusting those caring for them, and making decisions. Family members and clinicians are often anxious, frightened and uncertain, too, and in some cases can be hurt when the person is agitated or aggressive. Working in palliative care, we know too that the fear and angst of delirium gravely threatens the equilibrium and calm that many dying patients would otherwise reach, as well as carers’ reintegration in bereavement.
These aspects underscore why best delirium care profoundly matters, including on the last day of a person’s life.
Over the last decade we have been building understanding of how to improve delirium prevention, recognition and management for people receiving palliative care. Right now, I believe our best efforts and successes in these areas will come through a re-valuing of the simple things in life. By ‘simple things’, I mean fresh air, natural light and surrounds, movement, food and drink, sleep, cleanliness, and most of all, loving and meaningful connection and communication with others. These things help to protect human beings from delirium, and they matter to patients and families at the end of life. Our studies in Australian palliative care units and New Zealand hospices which focused on these aspects of care are showing great promise.
Simplicity also means to create clinical systems that make our delirium care not just better, but easier, too. To this end, we are now working on a study in four palliative care units to help integrate the Delirium Clinical Care Standard into usual ways of working, including via PCOC (the Palliative Care Outcomes Collaboration). The study is funded by a NHMRC Ideas Grant, demonstrating support for its innovation in palliative care.
Dr. Annmarie Hosie
Associate Professor, Palliative Care Nursing
University of Notre Dame Australia & St Vincent’s Health Network Sydney