Raise awareness for World #Delirium Day 15 March 2017

tom-eversley-86441.jpeg

Delirium is a favourite topic of ours at Palliverse – it is experienced by many people with palliative care needs, including at the end of life, and is often distressing to the person, their loved ones and health professionals providing care. Despite this, it remains poorly recognised, underdiagnosed and poorly treated – not least because the evidence base is still growing.

iDelirium, a federation of the Australasian Delirium Association, European Delirium Association and American Delirium Association, has launched World Delirium Day (#WDD2017) in an attempt to raise awareness of delirium and improve its management.

They have suggested some Actions to Take on #WDD2017. I’ve listed them below & with some thoughts on how to take action.

  • Commit to using the term ‘delirium’

If you hear someone using terms like “agitated”, “restless”, “aggressive” or “pleasantly confused”, think – could this be delirium? I use the term delirium, document it and make sure it’s communicated in the medical record and letters. Recognising and diagnosing delirium allows us to educate patients and their loved ones, as well as providing the best delirium care possible.

  • Screen your patients for delirium

People at risk of delirium, who should be screened, include those with serious illness, those aged over 65 years and those with underlying cognitive impairment. This includes many of the people cared for by palliative care services! The diagnosis of delirium may be missed, delayed or misdiagnosed without screening, as signs may be subtle (especially in hypoactive delirium).  There are multiple simple bedside screening tests for delirium, and although not all these have been validated in the specialist palliative care setting, they are still useful. The 4AT is a freely available screening tool that can be administered by any health professional and does not require training.

  • Listen to patient and family stories about the experience of delirium

What may seem “pleasantly confused” to staff members can be very distressing for the delirious person and their families. Being agitated, aggressive or “just not themselves” can be distressing for patients and families to witness – it is important to acknowledge these emotions and provide education about delirium. (See “Michael’s Story: the fear on his face was palpable” for a wife’s experience of her husband’s undiagnosed delirium.)

  • Engage your leadership in a discussion of delirium

If the above isn’t enough to convince your leadership to take note, delirium also increases the risk of health care complications like falls, pressure injuries, prolonged length of stay, and mortality. For those in Australia, World Delirium Day is a great time to introduce your leadership to the recently released Delirium Clinical Care Standard (which we’ve covered here before).

  • Educate health professionals about delirium

Delirium does not “belong” to just one group of health professionals or one specialty. It’s common, especially in palliative care, and important for us all to know about it.  Some of my favourite educational resources are freely available at the Scottish Delirium Association, plus this 5-minute video from UK-based  Delirium Champion Dr MS Krishnan. (I’ve shared this before but it’s worth sharing again!)

As a final bid to raise awareness, you can participate in a #WDD2017 Thunderclap via your Facebook, Twitter or Tumblr account, to alert your friends and followers to the importance of delirium.

Ramblings from the past, as I think about 2017…

Excellent writing from Kate Swaffer, with links to some of her previous posts. Her blog is essential reading for anyone who works with people living with dementia.

Creating life with words: Inspiration, love and truth

World Dementia Council members 2016 World Dementia Council members 2016

It is already mid January 2017, and I’ve not yet posted a blog, so am hoping to rectify the today! I started this ages ago, but have had trouble paddling since December so have not achieved very much at all. Anyway, it may be worth looking back and reflecting as we prepare for yet another year. The years certainly fly by so quickly as one gets older, which I wrote about many years ago, but cannot find that particular blog.

As I have a lot of new followers of this blog, I thought I’d highlight a few from over the years (easier than writing a new one, by the way!). The grief of dementia is one of the most unspoken of topics, not our grief families feel as we change and lose function, then die, but the grief we feel as we lose capacity and as our abilities change to disabilities, and we are…

View original post 500 more words

Living with grief & loss: #PallANZ chat

pallanz-201612

Grief and loss is something we will all face at different times throughout our lives. Whether it is the death of our pets, our friends, our children, siblings or parents; the experience and expression of grief in response to these losses can be a very personal and individual thing. Grief can also arise in anticipation of loss. For those living with life-limiting illness, living with the loss of social role and professional identity can be especially challenging.

Thoughts about old, new and future losses can be particularly common during the festive season. For some of us, it may represent an anniversary of the death of a loved one, and bring with it painful memories of loss. Some might be facing their first Christmas ‘alone’, while others may be grappling with the possibility of celebrating their ‘last Christmas’.

While living with grief and loss is a personal experience, we don’t have to endure it on our own. As a community, there are many ways that we can support each other. Join Palliverse and Palliative Care Australia CEO Liz Callaghan (@PCACEO) to reflect on 2016 and talk about grief and loss.

Carers and people with palliative care needs are especially welcome, as are health professionals, researchers, policymakers and interested community members!

If you are new to twitter and tweet chats, see our “idiot’s guide” here: https://palliverse.com/2014/09/03/idiots-guide-to-twitter-for-health-professionals-twitter-101/

Continue reading

Drugs for #delirium don’t work, and may in fact harm

Meera Agar, University of Technology Sydney

Delirium robs dying people of their autonomy, dignity and last conversations with loved ones, at a time when every moment is precious.

Symptoms are highly distressing to experience and watch. Confusion, incoherent communication, poor attention, agitation, drowsiness and hallucinations are some markers of this common complication for people dying in hospital from cancer and other advanced illnesses. On average one in three people in end-of-life hospital care are affected.

Doctors commonly prescribe antipsychotic medications to try to relieve these symptoms. However, our study just published in JAMA Internal Medicine, raises serious concerns about their safety and efficacy.

So, what are we to do for people experiencing delirium, who are robbed of their mental awareness and ability to communicate?

Continue reading

“Failure to maintain”: do hospitals cause suffering in older people?

Today Palliverse talks to Assistant Professor Kasia Bail (@Kasia_Bail) from the University of Canberra. Kasia is a nurse, a researcher, a kung fu instructor and a drummer in a metal band. She came to our attention via social media when we noticed her crowdfunding campaign for the next stage of her research into nursing care of complex, hospitalised older people. Here at Palliverse we are fans of crowdfunding, although we’re yet to use it for research purposes!

Kasia’s research aims to improve sustainable acute care health delivery for an ageing population, while her clinical experience includes general medical and acute palliative care. In her PhD, Kasia developed an approach to measure nurse-sensitive outcomes, which is currently being used to evaluate a Government-funded implementation of a cognitive identifier. Kasia has a passion for identifying and researching the structures and processes which impede or enable quality patient care, and sharing her learning and inquiry with nursing students, industry and professional groups. Here, Palliverse asks her about her latest research project and dipping her toe into the world of social media.

kasiabail

Dr Kasia Bail (image via Dr Bail)

Your research has led to a new concept in the care of older people with complex medical problems, “Failure to Maintain”. What does this mean? Continue reading

Delirium in palliative care – 10 tips in 140 characters

IMG_2618

Here are the first ten tips that came to mind for the management of delirium in specialist palliative care.* Of course, there are many more to list. Please share your top tips in the comments. Continue reading

Michael’s story: Delirium – “the fear on his face was palpable”

Delirium is a common, distressing complication of life-limiting illness, yet poorly understood, often misdiagnosed and poorly managed. The Australian Commission on Safety and Quality in Health Care (ACSQHC) recently launched its Delirium Clinical Care Standard. I was fortunate to attend the official launch event on 15th July 2016 – the stand-out of which was the powerful story of Michael, as told by his wife Joan Jackman, who was Community Representative on the Delirium Clinical Care Standard Working Group.

She has kindly allowed me to reproduce her speech here and I hope it will spark discussion about delirium, what we can learn from Michael and Joan’s experience, and how we can do better.

 

WayneRobinsonBoranup.jpg

Michael loved the Australian bush. Photo: Wayne Robinson

Michael’s story:

‘Every medical condition is about a person with an individual history, friends and family, and a personal story. The person in the centre of this story is my husband Michael – a healthy, fit, intelligent man – who had been a fitness trainer in the British Air Force before becoming a British-trained Remedial Gymnast in Rehabilitation, for people with a disability. He was an elite sportsman, with a love of life, and also for his family.

Around the age of fifty-nine or sixty, Michael began to experience changes, utmost being that he became increasingly disengaged –with us, and with life! Something was wrong! We sought help.  After three misdiagnoses and six years, Michael was finally diagnosed with a Younger Onset Dementia. He was by then, 66 years old.   Continue reading

Delirium: Why we should (palliative) care

In palliative care, delirium is everyone’s business. Anyone can get delirium if they are seriously ill. It is a distressing symptom – for the person with delirium, their loved ones and the professionals who care for them. Although it is common, potentially preventable and may be reversible, it is often missed, misdiagnosed and mismanaged despite our best intentions.

This 5-minute video is an excellent resource for the public and health professionals alike, (and seems to cover everything that it takes me 45 minutes to teach to nurses or doctors!). I discovered it via its co-creator, Delirium Champion Dr MS Krishnan.

This week, I am taking over Palliverse to share posts about delirium in palliative care – from conferences to clinical standards to a heart-wrenching personal story. Continue reading

#NPCW16 #PallANZ Tweetchat: Living Well with Chronic Illness

PallANZ 201605

Join next week’s #PallANZ tweetchat on the topic of “Living Well with Chronic Illness”, the theme of Australia’s National Palliative Care Week (#NPCW16). Anyone with experience of living with life-limiting chronic illness, having a loved one with chronic illness, or working with people with chronic illness, is encouraged to participate. You don’t have to be Australian, and Twitter newbies are welcome!

Australian Institute of Health and Welfare statistics show that most people who who access palliative care have cancer. However, palliative care can be of benefit to many people living with non-malignant diseases and chronic illness as well. These include dementia, heart disease, lung disease or kidney disease, to name a few. Many people could benefit from what palliative care can offer, such as management of pain and other symptoms, advance care planning for the end of life, and support for carers.

Continue reading

Call for abstracts – 2016 AAG Conference #AAGConf16

5519226596_7c96ffc914_z

While we’re on the subject of conferences being held in Canberra this year, the Australian Association of Gerontology (AAG) are extending the closing date for abstract submissions for their November conference, until Friday 29th April 2016.

The conference theme is “Capitalising on the Ageing Dividend: Reimagining Our Future” and submissions are welcome on a variety of ageing-related topics, including palliative care and end-of-life care.

What’s cool about the abstract submissions? Authors are asked to submit a 100-character “Tweetable” along with their abstract.

Visit the AAG website for more details on the conference and abstract submissions.

 

Photo: ‘The National Library of Australia and the Canberra Balloon Festival, March 2011‘ by Grey Nomad Australia, licensed under CC BY 2.0 Generic.