Transcript WHAT’S WRONG WITH AGNES? - European Delirium Association

Agnes is in a muddle
Agnes is an 84 year old lady who has been
living at your home for 4 years. Recently
the home changed the soap powder used to
wash residents’ clothes, and Agnes had an
allergic reaction to this. She was given an
antihistamine for this which she started
taking 2 days ago. On your last 2 night
shifts you have noticed that Agnes seems
restless in the evening, and often picks at
her bedclothes and moans in the night.
When you talk to her, she seems to find it
hard to follow what you are saying to her,
and she keeps jumping from one topic to
another. You mention this at handover,
and though the afternoon staff agree with
you that she seems a bit confused, the
morning staff comment that she does not
seem so bad in the morning.
What are the signs that she
might be delirious?
What could be the cause of
delirium?
Is Harold OK?
Harold is an 82 year old man who has
been living at your home for 5 years.
He has a diagnosis of Alzheimer’s
dementia. He has a catheter.
Harry does not wear a hearing aid, but
over the past week you have noticed
that he has been asking you to repeat
what you have said, and sometimes
seems to mishear you completely.
Over the last couple of days he has
been eating and drinking much less
than usual, and sometimes you have
noticed him rubbing his stomach.
What are the risk factors for
delirium?
There’s something not right
with Mrs Wright
Mrs Wright has recently come to live at
your home following a period of
hospitalisation for a fractured hip. Her
family report that previously she was
independent, if a little forgetful at times,
and coped living at home with the support
of meals on wheels. Following her
operation, Barbara became acutely
confused, shouting and trying to get out of
her bed at night. She was found to have
developed an infection in her wound site
and was given antibiotics to treat this. She
was also prescribed Lorazepam which
staff said settled her and stopped her
shouting out at night.
On discharge, hospital staff and her family
agreed that they did not feel that Mrs
Wright would be able to manage living by
herself, and she was transferred to your
home.
Since coming to your home Mrs
Wright has seemed quiet and
withdrawn. She does not seem to
know where she is, and has been
trying to get out of bed to wander
round several times at night. You have
heard her mumbling to herself in the
evenings, but it is hard to make out
what she is saying.
What questions might you
ask?
Lorna is not herself
Lorna has been a resident at your home for
the past 8 years. Although she first moved
to the home she initially seemed very
withdrawn, over the years she seems to
have enjoyed living here and has made
some good friends. Over the last few
months, Lorna has become increasingly
withdrawn and she no longer seems to
want to engage in conversation. She does
not seem to be sleeping well and she
seems more forgetful than usual. Her
appetite is reduced and needs several
prompts to wash and dress in the
mornings.
At the beginning of the year, one of her
good friends in the home died. Six months
ago another friend in the home moved to a
different unit due to worsening dementia.
Recently a staff member who Lorna got on
very well with was offered a new job in
another home.
Depression or Delirium?
What are the risk
factors for Delirium?