THE NHS has neglected a condition which affects up to half of all elderly patients after surgery and can leave them with lasting brain damage, a report has warned.
Delirium is now viewed as a medical emergency as serious as stroke, heart attack and pneumonia, and can leave patients at eight times the risk of contracting dementia.
However, detection rates have been described by one Scottish expert as 'dismal' and until recently nurses would explain to patients that "older people always get confused when they come into hospital".
Hospitals can cause patients to develop delirium, due to the busy unfamiliar environment, disrupted sleep patterns, bright lights and alarms common on some wards.
Anaesthesia and other drugs can produce delirium as side-effects meaning elderly people are particularly at risk after surgery, although it can strike at any age. Other causes of delirium include infections, constipation and dehydration.
The condition is marked by a sharp onset of extreme confusion, with possible delusions and an inability to focus or hold a conversation. It can be confused with dementia, but while the symptoms of dementia develop slowly, over years and months, delirium can appear suddenly, and patients can also recover more rapidly.
But the impact of the condition has been exacerbated in the past by a failure to routinely assess patients for delirium and a lack of knowledge about the triggers and how to treat them.
A report to be published today by Healthcare Improvement Scotland outlines improvements achieved in eight demonstration wards around the country, and says NHS resources could be saved and patients protected if healthcare staff adopt more rigorous procedures.
It calls for better training for NHS staff and more information for the public
The wards involved used a new tool, developed in Scotland, called 4AT to assess patients and a treatment package, the Time Bundle (Think, Investigate, Manage, Engage and Explore) to respond to the illness.
Edinburgh's Royal Infirmary, where the system was implemented in three wards, found that patients were less likely to fall as a result, stays in hospital were shorter and there were fewer complaints.
Falls are a major concern for patients who have experienced delirium. They are also much more likely to go into residential care rather than return home and have a greatly increased risk of dementia or further episodes of delirium. However experts believe many of these adverse results can be avoided.
Prof Alastair MacLullich, Consultant in Geriatric Medicine, at the Royal Infirmary of Edinburgh, said: "Delirium affects one in eight hospitalised patients. For many patients the experience will be the worst time of their lives.
"According to one study it leaves patients at eight times the risk of dementia, and they have 3-5 times the risk of being admitted to a care home. But you can't do much about it if you haven't detected it."
He added: "The cost to the NHS is huge. An orthopaedics bed costs £700 per day, and any patient with delirium will stay an average 3-5 days extra.
"This is a medical emergency like a heart attack, stroke or pneumonia, but it doesn't come with a simple test or set of symptoms."
Geraldine Marsh, was lead nurse at the Department of Elderly Medicine at Glasgow's Southern General Hospital, where a specialist 16 bed dementia delirium ward has already opened. She said delirium can be terrifying for patients and distressing for relatives.
"Patients will tell you 'I was away with the fairies last night'. They are in a strange environment with lots of stimulus and don't know where they are. If they think they are in their own house and a nurse or doctor comes through the door they can think it is an intruder. Families will say to us 'I can't cope with my mother or father like this, I will have to put them in a care home'."
However identifying the cause of a delirium and treating it is usually effective and relatives can be relieved and reassured, she said.
There are plans to expand the dementia delirium ward to 30 beds in the new south Glasgow University Hospital. However all wards, including geriatric, medical receiving wards and A&E need to become effective at screening for delirium, according to Healthcare Improvement Scotland which has produced a delirium toolkit for NHS staff.
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