Don’t go there; it’s not a nice place: Older adults experience of delirium during hospitalisation

Abstract

Delirium is a common medical disorder with neuropsychiatric symptoms that can occur during a hospitalisation, particularly in elderly patients. It may cause a transient alteration in consciousness and attention, cognitive functions and how those affected perceive what is going on around them (American Psychiatric Association, 2013). Delirium may cause a great deal of distress for the patient, their family and health care professionals. The long term sequelae can include an increased mortality rate, ongoing impaired cognitive functioning, and a higher possibility of discharge to institutional care. Despite the frequency of delirium for hospitalised older patients, there is a dearth of research that examines their experiences of this phenomena and how it may affect them as they continue their lives. This study uses a qualitative descriptive methodology to explore the question “What is the experience of delirium for older adults during hospitalisation?” Data for this qualitative descriptive study was collected from participants who had received hospital care in Auckland City Hospital. Recruitment took place between January and June 2017 from the medical, older peoples health, and liaison psychiatry services. A total of seven participants were recruited to the study. Semi structured interviews were used to gather the data which was then analysed using content analysis. An examination of ethical considerations was undertaken with an outline of the ethics approval process. The results of this small study demonstrated the distressing effects that delirium can have. The main themes identified by the participants were grouped around the headings of a sense of confusion, a loss of autonomy, perceptual disturbances, and emotional response. Some of the participants experienced parts of the delirium as like a dream state and some had a sense of detachment. The findings are congruent with the literature on the experience of delirium. An unexpected finding was that one participant felt distress on resolution of the delirium as he had forgotten the diagnosis that had led him to be in the hospital. Recommendations for practice include initiation of a delirium prevention programme hospital wide and an education programme to improve understanding, recognition and management of delirium. With the outcome that nurses will practise empathetically, using the concept of the nurse- patient relationship, with therapeutic use of self to support and assist those with delirium to integrate these experiences into their lives.