Timely review and monitoring is needed of people with delirium to confirm that they are improving and responding to treatment, where cognitive impairment persists people are referred on for further assessment.

People living with dementia are at higher risk of developing delirium. If they are diagnosed with delirium they will be managed and provided with treatment to improve their delirium. Cognitive tests and delirium screening should be repeated to ensure that their condition is improving and symptoms have subsided.

If somebody diagnosed with delirium is not responding to treatment and cognitive impairment persists they should be referred onward for further assessment and treatment.

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

Healthwatch

Healthwatch is your health and social care champion. If you use GPs and hospitals, dentists, pharmacies, care homes or other support services, we want to hear about your experiences. As an independent statutory body, we have the power to make sure NHS leaders and other decision makers listen to your feedback and improve standards of care. Last year we helped nearly a million people like you to have your say and get the information and advice you need.
Telephone: Call: 03000 683 000 between the hours of 08:30 – 17:30 Monday to Friday
Email: enquiries@healthwatch.co.uk
Weblink: https://www.healthwatch.co.uk/your-local-healthwatch/list

Evidence

Royal College of Psychiatrists NAD Round 3 report: "Medical and Nursing Directors should ensure that hospitals have robust mechanisms in place for assessing delirium in people with dementia including:

Cognitive tests administered on admission and again before discharge.
Delirium screening and assessment fully documented in the patients notes (regardless of the outcome).
Care offered in concordance with the delirium evidence-base recommendations when the assessment indicates symptoms of delirium.
Results recorded on the electronic discharge summary.
Ensure staff receive training in delirium and its relationship to dementia, manifestations of pain, and behavioural and psychological symptoms of dementia.

Research paper, Lancet Commission 2020:

Risk factors for delirium in dementia include sensory impairment, pain, polypharmacy, dehydration, intercurrent illnesses, such as urinary tract infections or faecal impaction, and an unfamiliar or changing environment.
Delirium in older people should prompt consideration of underlying dementia.
No definitive evidence that any medication improves delirium in people with dementia exists: cholinesterase inhibitors, antipsychotics, and sedating benzodiazepines are ineffective and antipsychotics and benzodiazepines are associated with mortality and morbidity.
People with delirium without known dementia are more likely to be diagnosed with dementia in the future than others, either because of pre-existing undiagnosed dementia or cognitive impairment, present, or because delirium has neurotoxic effects and so precipitates dementia.

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.