Monday, May 8, 2017

Something else about delirium, part 2

It's Number One!!

Every clinician working with patients and families facing advanced illness and at end of life must understand delirium. We already know to expect it, because that’s #5 on the Top 5 List.

Delirium, dementia, and depressions, “the 3Ds,” are frequently encountered in life-limiting illness and at end of life. Older patients are particularly vulnerable. A recent study found that nurses had generally low knowledge of the 3Ds, and were not able to effectively identify, differentiate, or intervene when one or more of the disorders affected their patients. 1

The clinical presentation of delirium varies widely. While many clinicians most often think of delirium as a state of extreme agitation and hyperactivity, the hypoactive and mixed forms of delirium occur more frequently in older patients. 2

It’s possible to spend hours, days, weeks, or an entire career exploring a specific topic like delirium.

Thankfully, it’s also possible to learn the essentials much more quickly. The folks at PC NOW (the Palliative Care Network of Wisconsin) produce Palliative Care Fast Facts and Concepts.

I’ve been lucky to work with physicians who understand palliative care and hospice, but if any at your agency need to be brought up to speed on any topic, grab this link and make sure they do something with it. It could be the most important contribution you ever make to good care.

#4 - Know what delirium is. A simple definition says it best - delirium is present when, “a patient’s ability to receive, process, store, and recall information is impaired.” 3


  1. Yaghmour, S.M. and Gholizadeh, L. (2016) Review of Nurses’ Knowledge of Delirium, Dementia and Depressions (3Ds): Systematic Literature Review. Open Journal of Nursing, 6, 193-203.
  2. Weissman, D. Rosielle, D. Fast Facts and Concepts #1: Diagnosis and Treatment of Terminal Delirium. 3rd Rev. November, 2014. Downloaded at
  3. Ely, W. et al. Confusion Assessment Method for the ICU - Training Manual. Rev. 2014. Available at