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Article
Publication date: 24 June 2021

Margaret Robertson

This essay was written as a university assignment for an expert dementia practice module as part of the Masters in Applied Professional Practice. This paper aims to provide a…

173

Abstract

Purpose

This essay was written as a university assignment for an expert dementia practice module as part of the Masters in Applied Professional Practice. This paper aims to provide a critical discussion of the recognition and management of delirium superimposed on dementia.

Design/methodology/approach

The findings of this paper showed that the recognition of delirium superimposed of dementia is not well recognized, but early intervention and management can result in preferential outcomes. This requires the use of appropriate recognition tools and for all health-care staff to have specific training within this area.

Findings

Education is imperative to improving delirium recognition.

Research limitations/implications

Education is imperative to improving awareness.

Practical implications

The research implications of this paper demonstrate that appropriate training and education of health-care staff is imperative for the timely recognition of delirium and the improvement of care.

Originality/value

This paper was undertaken as an assignment for the University of Highlands and Islands.

Details

Working with Older People, vol. 26 no. 1
Type: Research Article
ISSN: 1366-3666

Keywords

Open Access
Article
Publication date: 30 March 2020

Andrew Chunkil Park, Leigh Goodrich, Bobak Hedayati, Ralph Albert, Kyle Dornhofer and Erin Danielle Knox

The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative…

1122

Abstract

Purpose

The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal.

Design/methodology/approach

The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol.

Findings

While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium.

Originality/value

This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

Details

Mental Illness, vol. 12 no. 1
Type: Research Article
ISSN:

Keywords

Open Access
Article
Publication date: 23 November 2016

Alejandro Hernández-Sandí, David Quirós-Baltodano and Michelle Oconitrillo-Chaves

Delirium, or acute confusional syndrome, is a set of symptoms whose care involves not only psychiatry, but also many other medical specialties. Being as how the syndrome is caused…

Abstract

Delirium, or acute confusional syndrome, is a set of symptoms whose care involves not only psychiatry, but also many other medical specialties. Being as how the syndrome is caused by multiple factors, it is important to recognize each risk factor affecting the patient in order to anticipate and prevent it. In case of diagnosis, identifying and treating the root cause that triggered is important, given that it has a high rate of comorbidity and an elevated cost of medical care. We describe a case where a patient with hypothyroidism began suffering from delirium due to an abrupt discontinuation of levothyroxine treatment. Previously, the patient was seemingly healthy. After the medical treatment was interrupted, sensory processing and behavior were altered, and symptoms fluctuated, for a short period of time, showing disorientation and memory and language impairment.

Details

Mental Illness, vol. 8 no. 2
Type: Research Article
ISSN: 2036-7465

Keywords

Article
Publication date: 1 May 2009

John Lyne, Michelle Hill, Patricia Burke and Martina Ryan

The purpose of this paper is to examine an audit that was performed of all patients referred to a liaison psychiatry inpatient consultation service which sought to establish a…

676

Abstract

Purpose

The purpose of this paper is to examine an audit that was performed of all patients referred to a liaison psychiatry inpatient consultation service which sought to establish a baseline for demographics, type of referral, and management of referrals, with a view to introducing improved evidence‐based treatments. It also aims to examine timeliness of response to referrals benchmarked against published standards.

Design/methodology/approach

All inpatient referrals to a liaison psychiatry service were recorded over a six‐month period, including demographics, diagnosis, management and timeliness of response to referrals. The data were retrospectively analysed and compared against international standards.

Findings

A total of 172 referrals were received in the six months. Commonest referral reasons included assessments regarding depressive disorders (23.8 per cent), delirium/other cognitive disorders (19.2 per cent), alcohol‐related disorders (18.6 per cent), anxiety disorders (14.5 per cent), and risk management (12.2 per cent). Evidence‐based practices were not utilised effectively for a number of different types of presentations. A total of 40.1 per cent of referrals were seen on the same day, 75.4 per cent by the end of the next day, and 93.4 per cent by the end of the following day.

Practical implications

Use of a hospital protocol for management of delirium may improve outcomes for these patients. Evidence‐based techniques, such as brief intervention therapies, may be beneficial for referrals involving alcohol dependence. Referrals were seen reasonably quickly, but there is room for improvement when compared with published standards.

Originality/value

This paper provides valuable information for those involved in management of liaison psychiatry consultation services, providing ideas for development and implementation of evidence based practices.

Details

International Journal of Health Care Quality Assurance, vol. 22 no. 3
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 23 September 2009

Jennifer Torr

The dementias are important disorders of ageing which result in cognitive and functional decline, behaviour change, increasing dependency and premature death. Alzheimer's disease…

398

Abstract

The dementias are important disorders of ageing which result in cognitive and functional decline, behaviour change, increasing dependency and premature death. Alzheimer's disease and other dementias are at least as prevalent in older people with learning disabilities as in the general population. In addition, people with Down's syndrome have high rates of early onset Alzheimer's disease. Assessment of dementia in people with learning disabilities is confounded by pre‐existing cognitive and functional impairments and high rates of comorbid disorders. This paper discusses assessment of dementia in people with learning disabilities from a clinical perspective, with reference to the current evidence base.

Details

Advances in Mental Health and Learning Disabilities, vol. 3 no. 3
Type: Research Article
ISSN: 1753-0180

Keywords

Content available
Article
Publication date: 3 May 2011

160

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 24 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 17 December 2019

George J.E. Crowther, Cathy A. Brennan, Katherine L.A. Hall, Abigail J. Flinders and Michael I. Bennett

People with dementia in hospital are susceptible to delirium, pain and psychological symptoms. These diagnoses are associated with worse patient outcomes, yet are often…

Abstract

Purpose

People with dementia in hospital are susceptible to delirium, pain and psychological symptoms. These diagnoses are associated with worse patient outcomes, yet are often underdiagnosed and undertreated. Distress is common in people experiencing delirium, pain and psychological symptoms. Screening for distress may therefore be a sensitive way of recognising unmet needs. The purpose of this paper is to describe the development and feasibility testing of the Distress Recognition Tool (DRT). The DRT is a single question screening tool that is incorporated into existing hospital systems. It encourages healthcare professionals to regularly look for distress and signposts them to relevant resources when distress is identified.

Design/methodology/approach

The authors tested the feasibility of using the DRT in people with dementia admitted on two general hospital wards. Mixed methods were used to assess uptake and potential mechanisms of impact, including frequency of use, observation of ward processes and semi-structured interviews with primary stakeholders.

Findings

Over a 52-day period, the DRT was used during routine care of 32 participants; a total of 346 bed days. The DRT was completed 312 times; an average of 0.9 times per participant per day. Where participants had an identified carer, 83 per cent contributed to the assessment at least once during the admission. Thematic analysis of stakeholder interviews, and observational data suggested that the DRT was quick and simple to complete, improved ward awareness of distress and had the potential to improve care for people with dementia admitted to hospital.

Originality/value

This is the first short screening tool for routinely detecting distress in dementia in any setting. Its uptake was positive, and if effective it could improve care and outcomes for people with dementia, however it was beyond the scope of the study test this.

Article
Publication date: 30 December 2019

Kenneth Ken Siong Lee and Umi Adzlin Silim

The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP…

Abstract

Purpose

The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services.

Design/methodology/approach

All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan.

Findings

The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan.

Originality/value

Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.

Details

International Journal of Health Care Quality Assurance, vol. 33 no. 1
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 14 December 2020

Hilary Wilson

Social work involves working directly with people who are experiencing a crisis. An assessment is carried out to establish the best way forward and then reviewed after a period of…

682

Abstract

Purpose

Social work involves working directly with people who are experiencing a crisis. An assessment is carried out to establish the best way forward and then reviewed after a period of time to measure success or recalibrate the service. The current pandemic restrictions have all but ruled out meeting with people face-to-face. Now, professionals are usually required to don some form of personal protective equipment (PPE) when meeting with people and their families. Talking to an unknown professional who is behind a mask or on the telephone, about a personal issue is hard for everyone, but it is particularly difficult for people who may be further on in their dementia journey.

Design/methodology/approach

Critique

Findings

These impediments impact the social work assessment and review, meaning people may not have the quality of service they need and may end up paying for unnecessary provision. If admission to a care home is deemed necessary, the stakes rise considerably. A care home admission means contributing towards fees with pensions, savings and assets, including housing. Now, it comes with an additional health risk.

Originality/value

COVID-19 infection has impacted on the older population but residents in care homes with frailer physical health, cognitive impairment and delirium are at particularly high risk of dying.

Details

Working with Older People, vol. 24 no. 4
Type: Research Article
ISSN: 1366-3666

Keywords

Article
Publication date: 10 October 2011

Joy Duxbury, Frances Aiken and Colin Dale

The practice of restraint is controversial as deaths in care or custody have been a consequence of restraint. The purpose of this paper is to clarify research from national and…

1086

Abstract

Purpose

The practice of restraint is controversial as deaths in care or custody have been a consequence of restraint. The purpose of this paper is to clarify research from national and international literature to ascertain any common findings in order to provide guidance for staff on safe and effective restraint techniques where there is no other resort in the management of violent and aggressive individuals.

Design/methodology/approach

The researchers undertook a review of the literature on the medical theories relating to restraint‐related deaths and an analysis of deaths in custody in the UK for the time period 1 Jan 1999 to 1 Jan 2010.

Findings

Findings showed that certain groups are particularly vulnerable to risks while being restrained. There are also biophysiological mechanisms which staff need to be aware of when restraining an aggressive or violent individual.

Originality/value

It is evident that those in vulnerable groups when restrained in a prone position, or in a basket hold, for a prolonged period and who are agitated and resistive, are most at risk of death in custody. Consistency in reporting relevant deaths locally and nationally is necessary to facilitate analysis of key information and prevent deaths in custody in the future. Staff training and awareness are also key factors.

Details

Journal of Learning Disabilities and Offending Behaviour, vol. 2 no. 4
Type: Research Article
ISSN: 2042-0927

Keywords

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