Why can’t we do anything about delirium?

Abstract

Tens of thousands of NHS patients will develop delirium—and an alarming proportion die after the illness. Yet few people talk about it. Chris Stokel-Walker explores why My grandad had always said he was bulletproof, and I believed him. In his 92 years of life he had rarely been ill. In his late 80s he shrugged off a knee replacement like it was nothing, and recuperated incredibly quickly after an unexpected fall in his 90s led to an emergency hip replacement. He wasn’t blighted with the illnesses and health problems that affected his peers. Until he was. My grandad is one of the many people who have developed delirium, an often encountered but little spoken about condition that can change lives—or end them. Delirium is a state of sudden, acute confusion that is brought about by illness, infection, or changes to the patient’s environment. Some 1-2% of patients in primary care experience the condition,1 as do 8% of care home residents.2 In emergency departments 10% of attendees have it, rising to 25% of patients who have a hip fracture.3 For adults aged 18-65 a delirium diagnosis is associated with at least a doubling of 30 day mortality risk.4 One in four patients who score highest on a test designed to diagnose delirium die during hospital admission.4 Yet while official data from NHS England suggest that annually 71 000 people in UK hospitals have delirium,5 researchers say that’s a drastic undercount because of its lack of diagnosis.6 Some 55% of delirium diagnoses are missed among patients in emergency departments.7 “It’s something I wrestle with,” says Alasdair MacLullich, professor of geriatric medicine at the University of Edinburgh. “Why is something so common and so serious neglected on an …