Updated delirium care standard encourages the early recognition of people who are most at risk

The Australian Commission on Safety and Quality in Health Care launched the Delirium Clinical Care Standard (2021) at the 2021 Australasian Delirium Conference, aimed at preventing a condition which currently affects one in four medical patients.

Delirium is defined as a sudden change in a person’s mental state, it affects 50 per cent or more adult intensive care patients, and around 23 per cent of older patients in general medical settings.

Patients experiencing delirium may appear confused, disoriented and agitated and are often quiet or withdrawn.

The costs associated with delirium are estimated to be $8.8 billion a year.

The new standards look to prevent the condition in high risk patients, while improving early detection and treatment of patients affected.

Commission clinical director Dr Carolyn Hullick said the seriousness of delirium is not always appreciated and the updated standards encourage healthcare workers to be alert to changes in behaviour that may be due to delirium.

"The Delirium Clinical Care Standard has helped to embed the right processes into hospital care. The 2021 standard strengthens the need for patient information and involvement of carers and family, if the person wants this. The patient focus has never been more important than during this pandemic.”

Patients with delirium have worse health outcomes, including increased risk of death, longer hospital stays, higher risk of falls, a greater chance of developing dementia and an increased likelihood of requiring higher dependency care.

The commission estimates that delirium is potentially preventable in up to two-thirds of hospitalised patients.

COVID-19 has also exacerbated the problem. There is evidence to suggest it is more prevalent in COVID-19 patients and it is a common presenting symptom in older patients with COVID-19.

"Restrictions related to COVID have meant that support people for hospital patients have not always been able to be present, which has been difficult. This is a key challenge for people with dementia who are admitted to hospital, including those transferred from nursing homes,” said associate professor Gideon Caplan, president of the Australasian Delirium Association and director of Post-Acute Care Services and Geriatric Medicine at Prince of Wales Hospital Randwick.

“I applaud the work of the Commission in keeping this important standard up-to-date to protect Australians. I know it will make a real difference to the lives of patients, families and caregivers, as well as support healthcare professionals, so they can provide the best care for older people.”

Professor Susan Kurrle, a practising geriatrician who holds the Curran Chair in Health Care of Older People in the Faculty of Medicine and Health at the University of Sydney, welcomed the updated standard.

She also applauded the new patient-centred quality statement in the Delirium Clinical Care Standard, as it recognises the importance of carers and family members.

“Family and carers alert us when someone has changed their thinking or behaviour, so help us be alert to and diagnose delirium," she said.

"They can help support the person with delirium by being a familiar person, giving reassurance, orientation and encouraging the person to eat and drink. This helps prevent delirium. We need to recognise the vital role of the carer or support partner, particularly during COVID.

“In these most challenging times for health services – which are especially difficult for people with cognitive impairment in hospital – it is more important than ever to have a patient-centred perspective.”

The new standard can be found here. 

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