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Delirium can also be referred to as "sundowning" or "ICU psychosis" (American Delirium Society 2015). It may be frightening to family members who are often more aware of the changes in a family member's mental status than are the care providers. With the proper care, delirium can be prevented or minimized (Safer Healthcare Now!, 2013). Family involvement, particularly in critical care, does not reduce delirium incidence but improves psychological recovery (Black 2011).
Mr. Graham was admitted to hospital with dysphagia and weight loss. He was very confused and uncooperative, believing that staff were trying to poison him. On admission, Mr. Graham's wife explained that he had Alzheimer's disease and described to staff how he usually presented and what he was able to do for himself. She also advised that he had recently been admitted in a confused state to another hospital. Mr. Graham was in fact in the early stages of dementia and had retained good insight into his problems. To many people, he would not usually have appeared 'confused' because of his good social skills.
Unfortunately, the diagnosis of 'dementia' became dominant in his hospital notes, to the degree that this prevailed over his presenting health problems. Despite the details his wife had given, it was assumed that all of Mr. Graham's confusion was due to his dementia and that this was 'normal' and therefore did not warrant further investigation. Mrs. Graham did not feel that all her husband's confusion was due to his dementia, but staff did not seem to be listening, and so she contacted their mental health liaison nurse. The nurse's assessment revealed that Mr. Graham was suffering from anaemia and she recommended further investigation.
It was found that he had indeed been admitted to another local hospital just two months earlier with the same problem. He had received four units of blood and his delirium improved. Mr. Graham received a further blood transfusion and much of his confusion cleared, but his haemoglobin levels were not maintained, and he continued to lose weight due to his difficulty with swallowing. By now, Mr. Graham had become very quiet and subdued. Further investigations eventually followed, and Mr. Graham was found to have a malignant growth in his oesophagus. He died in hospital two weeks later.
Mr. Graham's case demonstrates the dangers of failing to recognize Delirium in people who have dementia and subsequently denying them the assessment and care they are entitled to.
It also shows the importance of listening to those who know the patient well. The need for improved communication and further training and education for hospital staff is also indicated by this case (Let's Respect 2006).
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