People with dementia admitted to hospital for acute care must always be assessed for the possibility of delirium.

If you need to be admitted to hospital you should be assessed for delirium.
Delirium is a condition which is more common among those people living with dementia. Being assessed for delirium means that you can receive treatment for that condition earlier if you have it. The hospital can also help lower the risk of you developing delirium during your stay in hospital.

For extra information, evidence and best practice please scroll down to the bottom of the page.

Regional offerings

Delirium Toolkits in Greater Manchester; Dementia United

The Greater Manchester delirium toolkits were designed for health and social care staff to use to help them identify and manage delirium in people over the age of 18 and not under the influence of drugs or alcohol. They are based on national evidence and include resources and training for both professionals and people with delirium and their families.
Weblink: https://dementia-united.org.uk/delirium/

National offerings

Age UK

Age UK is the country's leading charity dedicated to helping everyone make the most of later life. Providing advice, support, information, fundraising, local services
Telephone: Advice line 0800 678 1602 free to call 8am - 7pm 365 days of the year
Weblink: https://www.ageuk.org.uk

Alzheimer’s Society

The Alzheimer’s Society provides reliable and up to date information to help you with every aspect of living with dementia.
Telephone: National Dementia Helpline: 0300 222 1122. Open 9.00am. – 5.00pm. Monday to Friday & 10.00am. – 4.00pm. Saturday and Sunday.
Weblink: https://www.alzheimers.org.uk/

Dementia UK

Dementia UK is a national charity, committed to improving quality of life for all people affected by dementia. They provide Admiral Nurses, who work with family members and carers in all care settings along with a helpline for family members or carers who would welcome accessing advice and support.
Telephone: 0800 88 6678
Email: direct@dementiauk.org
Weblink: https://www.dementiauk.org/

Lewy Body Society

The Lewy Body Society is a charity whose mission is to fund research into Lewy body dementia and to raise awareness of the disease. The website provides information, support, resources and advice.
Telephone: 01942 914000
Weblink: https://www.lewybody.org/

NICE Dementia Guidance

This guideline brings together all the research and evidence which covers assessment, diagnosis, treatment and support. It is for people at risk of developing dementia, people who are referred for assessment, people living with dementia as well as being for family and friends and health and social care staff and commissioners. It aims to improve care by making recommendations on standards people should expect to receive from their assessment, care and support as well as on training.
Weblinks:
We have provided links to the NICE guideline for dementia and a further link is provided to guidance on how to delay or prevent the onset of dementia.
National Institute for Health and Clinical Excellence (NICE) NG16 (2015) Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset: https://www.nice.org.uk/guidance/ng16
National Institute for Health and Clinical Excellence (NICE) (2019) Dementia: assessment, management and support for people living with dementia and their carers: https://www.nice.org.uk/guidance/ng97

Evidence

Dementia Standard Contract Indicator 2018/19 Guidance: This indicator aims to maintain the identification of patients with dementia and delirium at a high level, to prompt appropriate referral and follow up after they leave hospital and to ensure that hospitals deliver high quality care to people with dementia.

Royal College of Psychiatry 2018: The medical and nursing directors for each trust should create procedures to be implemented across the hospital for: assessing, recording and following up people with a diagnosis of delirium by ensuring that all staff likely to treat people with delirium have appropriate training on how to recognise, investigate and manage people with delirium, including the different types / clinical presentations of delirium and approaches for managing them and ensuring effective communication about delirium throughout admission and to GPs on discharge.

NICE Quality Statement, Delirium in adults: "Adults newly admitted to hospital or long-term care who are at risk of delirium are assessed for recent changes in behaviour, including cognition, perception, physical function and social behaviour. Statement 2 Adults newly admitted to hospital or long-term care who are at risk of delirium receive a range of tailored interventions to prevent delirium. Delirium is potentially preventable, and interventions can be effective in preventing delirium in adults who are at risk. These preventative measures should be tailored to each person's needs, based on the results of an assessment for clinical factors that may contribute to the development of delirium. Such clinical factors include cognitive impairment, disorientation, dehydration, constipation, hypoxia, infection or other acute illness, immobility or limited mobility, pain, effects of medication, poor nutrition, sensory impairment and sleep disturbance.

People with frailty may present differently from other patients. They often have nonspecific signs and symptoms, such as delirium, reduced mobility and a history of falling, and not the ‘textbook’ diagnostic indicators of a particular condition. Their condition should not be interpreted as lacking seriousness or urgency because of this – it relates to the underlying pathophysiological processes emerging across several body systems simultaneously and to communication challenges. Both the underlying medical conditions and the presenting syndrome need attention. "

National audit of dementia round 4 report online: "Medical Directors and Directors of Nursing should ensure that people with dementia admitted as an emergency are assessed for delirium using a standardised tool such as the 4AT"

Best Practice Resources

Greater Manchester Community Delirium Toolkit: : https://dementia-united.org.uk/delirium-community-toolkit/

Assessment of delirium: use of 4AT and Delirium TIME bundle for early management and prevention of delirium.