A small exploratory study of the reaction of older people to an episode of delirium

Abstract

Delirium or an acute confusional state, occurs as a result of disease or physiological imbalance secondary to impaired brain function. One of its main clinical features is widespread cognitive impairment, which causes patients to become disconnected from their immediate surroundings and misinterpret reality. It has a sudden onset and its duration is relatively brief. Some authors take the view that delirium might be interpreted as a precursor to dementia. The aim of the study was to retrospectively explore older peoples' experience of an episode of delirium. In particular, whether they knew what had caused and cured it; and whether it had left them with any unresolved feelings of anxiety. A cross sectional design using grounded theory methodology was chosen, as being the most appropriate method for exploring this issue. A sample of 19 patients was selected using predetermined criteria, and engaged in a semi-structured interview with the researcher, in the ward environment. The interviews were audiotaped, transcribed, and analysed using the constant comparison method. Those interviewees who had illusions and hallucinations, were often able to describe their experiences in detail. They ranged from being pleasant and entertaining, to horrible and frightening. They were also able to remember short verbal commands from nurses during the episode of altered perception. Others remembered, or chose not to remember, very little. Few interviewees appeared to know exactly what had caused and cured the delirium, although some were able to tentatively connect the experience to their present medical condition. There also appeared to be little evidence of therapeutic communication with nursing staff once the episode of delirium had resolved. Although no one connected the experience with dementia, there did seem to be some evidence of mildly disturbed feelings, on reflecting back over the episode. As interviewees were generally willing to discuss their experiences with the researcher, it suggests that it would be helpful for nurses to provide opportunities to do so. Nevertheless, interviewees appeared to regard the episode simply as a transitory event in the overall context of illness, admission to hospital and their future welfare. The latter was of prime concern; yet again it appeared that they did not always receive the information they required to maintain control over their personal destinies.

The meaning of acute confusional state from the perspective of elderly patients

“…This may well have influenced what the patients revealed during the interviews and their capacity to retell and remember. Earlier studies (Laitinen, 1996;Schofield, 1997) have shown that the patients did not remember particularly well. In these studies, however, the patient and the interviewer met only after the patient was lucid again.…”

Postoperative Delirium After Colorectal Surgery in Older Patients

“…Family involvement is especially important because older patients and their families often have unarticulated fears that an episode of delirium is an indication of impending or developing dementia. 68 This problem is compounded if patients remember their delirium experience; they require further reassurance that the delirium is a transient cognitive impairment related to their physical illness.…”

Delirium: the role of psychiatry

“…Recovered patients are often uncomfortable discussing the experience, but most do recognise its transient nature (Schofield, 1997). Simple clarification can reduce the likelihood of patients or their relatives misinterpreting an episode of delirium as evidence of brain damage or as the first step towards senility or madness.…”