Delirium and Other Altered Cognitive States

Delirium is a common complication following surgery, particularly among older patients. Often described as an ‘acute confusional state’ delirium can take the form of hyperactive, hypoactive, or mixed delirium. Prompt diagnosis, and its causal factors, is vital in optimising management and recovery from delirium. While pharmacological management has its place within delirium care, non-pharmacological care and interventions are central to optimising outcomes. Many practitioners feel they lack knowledge when it comes to the best delirium care although many of the key interventions can be carried out by any healthcare professional. Dementia and depression can also affect a patient’s experience and their outcomes. While different in their own rights, ‘the 3 D’s’ (dementia, depression, delirium) can be mistaken for each other, leading to misdiagnosis. Practitioners should feel confident in how to recognise each and how the management for each can be both similar and unique. With all cognitive impairments the patient’s ability to give consent, or not, should always be considered. Steps should be taken to optimise their decision-making abilities or confirm a lack of capacity via formal testing.