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MANAGEMENT OF ACUTE CONFUSIONAL STATES
Before diagnosis and management, the important fact of a carer recognizing that something is wrong has to occur. This may be straightforward if the confusion is associated with markedly abnormal behaviour plus incontinence or other physical symptoms. It is less easy when the confusion is not severe and there are no obvious other symptoms. If an elderly person becomes confused and this is picked up by carers, medical advice should always be sought. The sufferer themselves may be reluctant to see a doctor and carers may ‘not want to bother the GP’ but these feelings should be overcome because the sooner the correct diagnosis is made the better the outcome.
Once the cause is found, specific treatments can be given. In the more serious cases admission to hospital may be necessary. Common causes such as urinary tract and chest infections usually respond very well to antibiotics. Confusion associated with slight strokes may take longer to respond. In addition to the specific treatment of the cause of the confusional state, there are general measures that can be undertaken both at home and in hospital. The elderly person should be cared for in a calm environment. Loud noises (frightening for anyone) should be avoided and the room should be well lit. This will help stop the sufferer misinterpreting shadows etc. and thus forming visual hallucinations. If very confused the person should have a carer present. This will lessen the person’s anxieties and the carer will be able to cater to their needs (drinks, trips to the toilet etc.) If in hospital, the patient should be allocated the same nurse as often as possible to avoid frightening frequent changes of faces. A quiet, warm, well-lit room has a very calming effect on an agitated confused person. The drinking of plenty of fluids should be encouraged (water, tea and diluted squash NOT the super-concentrated sugary fizzy drinks guaranteed to make almost all old people develop sugar diabetes.) The taking of full meals for a few days is less important.
Treatments will obviously take a few days to work and during this time the elderly person may be quite agitated and distressed. Someone in this state must never be physically restrained unless they are just about to do something harmful to themselves or others, then minimal force should be used to stop the action. Restraining encourages aggressive outbursts. A guiding hand and calm but firm voice works well and distracting tactics are effective. Tip-back chairs with restraining trays, cot-sides and a tying down of limbs have no place in the management of acute confusion or any other state and should be abhorred. If a person is in great danger of falling out of bed due to agitation, then the mattress should be placed on the floor. Cot-sides and tip-back chairs by increasing the agitation mean that the confused person can injure themselves very badly, defeating the desired effect.
*13/128/5*