In a recent article published in the Journal of the American College of Surgeons, postoperative delirium in older adults continues to challenge the medical profession. As caregivers, we often miss the signs of delirium in our residents unless there has been a significant event such as surgery. It is important to remember that delirium can occur without a major event and can contribute to negative outcomes.

Knowing a resident’s baseline status is key to identifying changes early, recognizing signs and symptoms of delirium and avoiding unnecessary treatments/medications. It is important that we remind our staff of what the signs and symptoms are and discuss residents experiencing a change in condition at morning meeting. Here is a list of some of the key symptoms of delirium:

1. Change in level of arousal, drowsiness
2. Abrupt change in cognitive function including problems with attention, difficulty concentrating, new memory problems, new disorientation
3. Difficulty tracking conversations and following instructions
4. Thinking and speech that is more disorganized, difficult to follow, slow or rapid
5. Quick changing emotions, easy irritability, tearfulness
6. Expression of new paranoid thoughts or delusions
7. New perceptual disturbances
8. Motor changes such as slowed or decreased movement; purposeless fidgeting, difficulty maintaining posture
9. Sleep/wake cycle changes
10. Decreased appetite
11. New incontinence of urine or stool
12. Fluctuating symptoms and/or level of arousal over the course of minutes to hours

It is also important that an appropriate delirium screening tool be used when assessing a resident. The US National Library of Medicine National Institutes of Health has a list of recommended assessment tools on the link below:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782167

Remember, we have the ability to identify and treat delirium, the key is understanding the process. Educate your staff on the importance of early detection and treatment and maybe avoid a negative outcome!