First week back at work. Holidays have the peculiar effect of feeling like you’ve been away for ages but also never left. There’s the inevitable gazzilion emails to wade your way trough. Unless of course you set it to auto delete but I gather that’s frowned upon now….
It’s been quite a full on week that started with a presentation at a conference for care home staff on delirium and dementia. Delirium is something I’m particularly passionate about it so it was fantastic to be talking with people who play such a vital role in their care.
Delirium can be a devastating illness that can affect anyone of any age however it affects older people more commonly.
At the start of any presentation I always start with the same question: ‘What does delirium mean to you?’ So it was with total dismay and frustration that to area of the media delirium would appear to mean criminal behaviour.
The headline ‘Over-75s perpetrators of NHS assaults’ immediately conjures up images of staff being assaulted in a deliberate act of violence by old people.
The language used to describe the fear and distress of older people without once mentioning the word delirium was particularly upsetting. There are people out there trying to make a difference, educate and change perceptions. An excellent blog written in response to this was by a Geriatric Registrar Dr James Woods (@jmwoods87)
One of the ways I try to challenge people in their attitude and behaviour is to talk about ‘Jimmy’. Jimmy is a fictional person but his story is a fairly typical account of the people we see with delirium. I take them through what may’ve caused his delirium and its subsequent effects. I then pause and put up pictures of crying babies. The story is repeated word for word only this time Jimmy is 9 months old. He is frightened. He is distressed. He is alone.
What do we think about Jimmy’s behaviour now? Do we repeatedly tell him to be quiet? Do we tell him to stop moving around? Do as many as 30 different people meet Jimmy but not explain who they are? Do we keep his favourite toy/security blanket from him?
What do you do instinctively for your child and why do we forget the fundamental basics when looking after an older person with delirium?
And l ooking after a person with delirium should be instinctive. It’s common sense and it shouldn’t be that hard.
Going into my on call on Wednesday I knew that the vast majority of the older people I would see would have delirium. I also knew that the families and carers of these people would be extremely worried and stressed about their loved one.
I’m a big fan of open hours for visiting as it’s an opportunity to talk to families and hopefully, to a chance to reassure them. At the very least I try to be as honest as I can. That can be tough though. Sometimes you are the emotional punchbag for a lifetime of family dysfunction and issues that have absolutely nothing to do with you. You just happen to be the person who appeared in that moment of crisis.
As cliched as it may be I honestly think the best thing to do is just listen. After that, give the best care you can. Part of that can be to remind people that ‘bed 6’ has a name or to ask them to pause a minute to think about how they might feel if their mum/dad/husband etc was admitted – what would you want for them?
So it seems crazy to me that we have to teach or even remind people of this. When did we stop doing this?
Kate Granger died today. She spent the later part of her life reminding people of this very thing. The work she did in this was nothing short of amazing but it saddens me that there was a need to do it in the first place.
Next week will be different and the same. I will do the best I can. I will encourage others to do and be the best they can.
Hopefully, in time, there will be no need to remind people. Instinctively people will just know….