Dementia and Delirium

Prevalence

• Around 944,000 to 1 million people with dementia in the UK (Alzheimer's Society, 2024).
• This number is projected to rise to over 1.4 million by 2040.
• One in 11 people over the age of 65 have dementia, though the prevalence rate among older people in the UK is also estimated at 7.1%. 
• More than 70,000 people live with young onset dementia (before the age of 65).  
• 25% people in hospital will have a diagnosis of Dementia (2024) which equates to 1 in 4 of our patients.

• Alzheimer's disease - 60-70%of dementia cases
• Vascular dementia - 10-20% of dementia cases
• Frontotemporal dementia - 10% of dementia cases
• Lewy Body dementia -5% of dementia cases
• Other  dementias - 5% of dementia cases

There are lots of different symptoms of Dementia that include but are not limited to:

• Memory loss (especially short-term memory)
• Poor concentration
• Struggling with familiar tasks
• Difficulty planning tasks
• Comprehension delay
• Difficulty with language & communication
• Personality changes
• Judgement
• Emotional lability
• Mood changes

Socially inappropriate behaviour

• Eat a healthy, balanced diet and maintain a healthy weight.
• Exercise regularly.
• Keep your blood pressure and cholesterol levels healthy.
• Limit alcohol intake: and avoid smoking.

• Protect your head: by wearing seatbelts and appropriate safety gear for sports.

• Manage hearing loss: and address mental health issues like depression.
• Stay socially active: and maintain social connections.
• Continue learning: to build cognitive reserve.

Verbal communication tips

• Speak clearly and slowly- Use a positive and friendly tone of voice. 
• Keep it simple- Break down complex information into short, simple sentences. Focus on one idea at a time. 
• Simple questions- Try yes/no questions or two-choice questions rather than open-ended ones. Ask one question at a time. 
• Allow time to respond- Allow for pauses between sentences as some people will need time to process information. 
• Repeat information: If you're unsure they've understood, repeat yourself or write down key words if they can still read. 
• Use their preferred name – try to avoid using pet name

Non-verbal communication tips

• Make eye contact 
• Use gestures
• Use visual aids/ photos/memory books
• Use touch (if appropriate) - gentle touch, like holding hands or a comforting hug, can reinforce spoken words and offer reassurance. 
• Position yourself appropriately at eye level

What can we do to help in hospital?

• Promote orientation and feeling of comfort for the patient
• Reduce extra noise where possible
• Provide stimulation and engagement in familiar routines / activities e.g., reading the newspaper, completing puzzles, reading or walking
• Ensuring they have their sensory aids. Life is hard enough in the hospital without being able to see or hear. Ensuring they have their glasses and/or hearing aids with them and that they are on.
• Encourage oral nutrition and hydration
• Make sure that their bowels are opening regularly and if not providing mediations that might aid this movement.
• Staying active - sitting out in the chair daily where appropriate and moving around the ward.
• Encourage healthy sleeping habits
• Completing a 'This is me' document- this document helps care staff see the person behind the diagnosis - their history, preferences, personality - which supports more respectful, person‑centred care. Having this information can reduce confusion and distress when they enter the unfamiliar environment of the hospital.
• Bringing in photographs for the bedside - Hospitals can feel clinical, impersonal, and frightening - especially for elderly patients. Photos offer emotional warmth, reminding patients they are loved and not alone. They can reduce anxiety, loneliness, and fear, especially during long stays or if family cannot visit often.
• Bringing in familiar items or clothing – everyone has a pair of favourite shoes or slippers or a favourite cosy jumper, and these items may help your loved one feel more at home, relaxed and therefore less muddled and comfortable

Delirium prevalence in UK hospitals is significant, with general estimates of around 20% to 30% in medical wards and higher rates in specific groups like intensive care units (up to 80%) and post-surgery (up to 50%).

The prevalence is generally higher in older adults and those with pre-existing cognitive issues.  This is around 1 in 10 patients in hospital

There are three types of delirium that all present in different ways:

Hyperactive Delirium: a sudden, short-term change in the brain that makes a person confused, restless, and overly active. They might experience the following:

• Agitation
• Restlessness
• Poor sleep
• Hallucinations
• Easily distracted
• Delusions
• Aggressive behaviour

Hypoactive Delirium: a sudden change in the brain that makes a person very quiet, sleepy, and slow, instead of restless. They might experience the following:

• Lethargy
• Become withdrawn
• Have poor nutritional intake
• Slowing of speech
• Lack of interest in previous hobbies/interests
• Seems to have low mood

Mixed Delirium: Can fluctuate between hypoactive and hyperactive during the day or day by day

The acronym "PINCH ME" stands for common causes of delirium and is used by healthcare professionals to identify triggers for sudden confusion in a person, especially the elderly. 

The medical team will ensure the following are completed to reduce the risk of developing delirium or to look for possible causes of the change in behaviours seen on the ward.

• P = Pain Identify and manage any pain
• I=Infection Treat the cause of the infection e.g chest or UTI
• N=Nutrition Encourage good oral intake and nutrition
• C=Constipation Treat constipation/ ensure bowels opening regularly
• H=Hydration Ensure good fluid intake
• M=Medication Make sure that all their regular medications being taken and review medications to see if there is something that could contribute to the symptoms of delirium
• E=Environment Think about the environment around them and how to create a good environment for the patient

• Promote orientation and feeling of comfort for the patient
• Reduce extra noise where possible
• Provide stimulation and engagement in familiar routines / activities e.g reading the newspaper, completing puzzles, reading or walking
• Ensuring they have their sensory aids.
• Encourage oral nutrition and hydration- make the team aware of meals your family members might enjoy.
• Staying active- sitting out in the chair daily where appropriate and moving around the ward.
• Encourage healthy sleeping habits
• Bringing in photographs for the bedside- Hospitals can feel clinical, impersonal, and frightening—especially for elderly patients.
• Bringing in familiar items or clothing – everyone has a pair of favorite shoes or slippers or a favorite cosy jumper, and these items may help your loved one feel more at home, relaxed and therefore less muddled and comfortable