Delirium In Older Adults

Running head: DELIRIUM IN OLDER ADULTS

Delirium in Older Adults Marissa Brown Trent University

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Delirium in Older Adults Introduction Having a placement on an integrated stroke rehab unit involves interacting with clients with varying levels of disability post-stroke. This variability arises because of their age, comorbidities and the size and acuteness of their stroke. After placement on the unit for about eight weeks, I have noticed that majority of clients receiving rehabilitation are over the age of 65 years old. When caring for an older adult, there are certain precautions to be taken when administering medications, ambulating the client as well as assessing mental state. One week in clinical, I was caring for a client who was receiving rehabilitation for an above the knee amputation and treatment for a urinary tract infection (UTI). Below, I will discuss my experiences with this client and the relevance to my future practice. Identification On the first day I cared for this client, she was alert, oriented and able to follow commands. I assisted this client with AM care and performed my required assessments. With the assistance of my nurse, we transferred her to her wheel chair with the assistance of the mechanical lift. Throughout the shift, this client was able to ask for items that she needed such as fresh water as well as assist me with getting her dressed. On the second day that I cared for her, this client was calling out and acting very differently than she was the day prior. When I introduced myself to the client that day, she was muttering words that were incoherent and did not make sense with the flow of conversation but was oriented to place. Throughout the day, this client was very drowsy and lethargic and because of this, the primary nurse and I decided to leave her resting in bed. Right before lunch, I went in

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to perform care on the client and assist her with feeding. The client was trying to communicate with me, but I could not understand. During this time, the client was becoming increasingly agitated and frustrated that I could not understand what she was trying to say. At one point, the client insisted on getting up into her chair and when I explained that the physiotherapist was going to come in and do some bed exercises with her, she became more upset and agitated. Eventually, with the assistance of the primary nurse we transferred her into her chair. After this, the client was again very drowsy and the primary nurse did not feel comfortable leaving her in her chair, so we placed the client back in bed. The next week, I was not assigned to this client but entered the room to assist her with opening her breakfast items. Even from the short conversation with this client, the change in her mental state from the following week was night and day. The client’s speech was coherent, and sentences made sense and she did not appear agitated at all. Description This experience made me feel frustrated, scared and at times empathetic for this client. When the client was acting out and getting upset with me, I was getting frustrated because I wanted to help the client but did not know how to effectively communicate with her. I tried to be calm and reassure her that everything was alright, but I could tell she was getting upset. In that moment, I could tell that the client was getting frustrated as well because she was trying to communicate with me but was not making any sense. I can imagine that being hospitalized and not being able to complete tasks for yourself can make you feel helpless and then if you are unable to communicate on top that can be very frustrating. The next week when I revisited this client, I was very shocked to see that she was back to her normal self. I was happy that she was no longer agitated and confused and that she was on

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the road to recovery. It surprised me that the client’s behaviours and mental state can change so quickly. Throughout this experience, I knew that I had to comfort the client and try to understand what she wanted without getting frustrated myself. I tried to stay calm and have a positive attitude with this client so that I could control and deescalate the situation Significance After this experience, I found out through a post-clinical presentation that this client was most likely experiencing delirium related to her UTI. This information helped me to understand why her mental state changed so abruptly as well as what I can do in future similar experiences. Delirium can be characterized by disruptions to cognition, awareness and attention that develop quickly and occur in about 50% of hospitalized older adults (Martins et al., 2018). Since delirium can cause the client to be unable to communicate with health care providers and family members, delirium can be considered a traumatic experience for both the client, family and health care providers (Martins et al., 2018). This experience made me feel distressed at times and in hindsight, wished I had more information regarding delirium beforehand. A study performed by Martins et al. (2018), suggested that further support and training about delirium and those who are at high risk, for health care staff can help to decrease the distress they may feel when caring for clients in a delirium state. In this experience, I used my prior knowledge of therapeutic communication in order to interact with this client while she was confused and agitated. Since she as having trouble communicating, I asked her closed ended questions in order to understand her needs easier. In this situation I also tried to relate to what my client was feeling in order to help meet her needs. Implications

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This experience and reflecting back on it is important for my further practice as it can help me to understand the risk factors and signs of delirium in older adults as well as how to interact and support a client in a delirium state. A study performed by Avendaño-Céspedes et al., emphasizes that nurses play an important role in prevention and interventions associated with delirium in older adults (2016). They state that nurses are required to recognize delirium and the risk factors in order to decrease the prevalence and provide effective interventions (AvendañoCéspedes et al., 2016). Based on this past experience and what the literature states it is important for nurses as well as nursing students to have the required knowledge about delirium and its triggers such as infection or certain medications. This experience can assist me in my future experience because I will be able to identify the signs and triggers of delirium and be able to act upon the issue. This knowledge will also make me more confident when interacting with clients in a delirium like state as well as voicing my concerns about treatment strategies that may increase the risk for a client to develop delirium. Conclusion Overall, I believe that I acted professionally and calm in this situation although I felt very uncomfortable on the inside. I could relate to the way the client was feeling and tried my best to make her feel comfortable and respect her wishes. I believe I could have been more prepared for this situation if I had known more about delirium and how to assist them while in this state. I believe that it is important for nursing students and other staff to know what to do in this type of situation in order to provide effective and therapeutic care. Finally, this experience has shown my need for further education on the topic of delirium in order to feel more comfortable in my future practice.

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References Avendaño-Céspedes, A., García-Cantos, N., González-Teruel, M. d. M., Martínez-García, M., Villarreal-Bocanegra, E., Oliver-Carbonell, J. L., & Abizanda, P. (2016). Pilot study of a preventive multicomponent nurse intervention to reduce the incidence and severity of delirium in hospitalized older adults: MID-nurse-P. Maturitas, 86, 86-94. doi:10.1016/j.maturitas.2016.02.002 Martins, S., Pinho, E., Correia, R., Moreira, E., Lopes, L., Paiva, J. A., . . . Fernandes, L. (2018). What effect does delirium have on family and nurses of older adult patients? Aging & Mental Health, 22 (7), 903-911. doi:10.1080/13607863.2017.1393794