Why Families Have an Advantage in Delirium Prevention
HELP brings in medical staff if delirium develops. But the preventive program is mostly non-medical. It answers each of the six targeted risk factors with these simple interventions:
Dehydration: Encourage drinking, unless fluids are restricted for some reason.
Immobility: To the extent possible, help the person go for walks or encourage him or her to move arms and legs in bed.
Sleep deprivation: When disrupted sleep cycles are a problem, the medical team can decide not to wake the person at night to check vital signs if it’s not essential. Volunteers — or families — can alert the staff to sleep problems. They can also move the person toward a normal sleep cycle by helping the patient stay awake during the day and creating a quiet, peaceful sleep environment in the evening. HELP volunteers use aromatherapy and hand massage to soothe patients.
Hearing impairment and vision impairment: “A lot of people don’t bring their hearing aids [to the hospital] because they’re afraid they’re going to get lost and they’re expensive,” Duncan said. But when families know about delirium and hearing impairment as a risk factor, they can make sure their loved one has hearing aids in place and a supply of batteries. The same is true with glasses and dentures, to help the person stay attuned to the environment and communicate clearly.
Cognitive impairment: At Methodist, everyone enrolled in HELP gets a folder of word and number games and coloring supplies for mental stimulation. Beyond that, volunteers try to learn patients’ personal interests and abilities so they can match them with a lending library of music, tablet computers loaded with games, books, audiobooks and even craft supplies, such as knitting baskets. Family members already know about personal interests and can bring favorite things from home.
Families also know something that’s even more important in preventing, detecting and managing delirium and that’s their loved one’s normal personality and normal cognitive abilities. Knowing those things, families are often the first to notice changes.