Is Donald Trump’s Press Secretary suffering from an acute delirium?

img_5540This was one of the questions I asked myself in the week that saw the reality TV star inaugurated as the new President of the United States.  As we know during a delirium there is:

1. disturbance of consciousness (i.e., reduced clarity of awareness of the environment)

2. the development of a perceptual disturbance that is not better accounted for by a pre-existing, established, or evolving dementia

These two points came to mind as I listened to the explanation regards the diminished numbers of people who turned out to watch the inauguration.

‘This was the first time in our nation’s history that floor coverings have been used to protect the grass on the MallThat had the effect of highlighting any areas where people were not standing, while in years past the grass eliminated this visual’

In contrast we couldn’t fit anymore people in at Erskine for the delirium and dementia education day.

The evidence for delirium in care homes is poorly understood.  I think a lot of this has to do with the focus on acute care.  However there is increasing acknowledgement that care home staff probably care for as many, if not more, people with delirium.

One statistic puts the prevalence of delirium as somewhere between 8 -15%  Derek Barron, Director of Care, tried putting that in context for the staff. Erskine Home has 180 beds which could mean 14 – 27 residents could have a delirium right now.  More to the point do staff know for sure who those people are?

The reality of caring for people with delirium and dementia is not something I needed to teach the Erskine staff.  That would be hugely disrespectful for a start.  What I had hoped to get across was some of the understanding around delirium and how to diagnose/manage it.  Central to this is my belief that we should be challenging our own behaviours instead of those we believe to exhibit ‘challenging behaviours’ towards us.

This was something Janice McAllister spoke of in her talk on dementia.  We are ‘disabling people with our behaviours and attitudes’.  Janice was able to help us see life through the eyes of a person with dementia.  More importantly she was able to make us realise that it is the simplest of things that can make the world of difference.

Janet, head of physiotherapy, spoke about her approach of ‘do with’ rather than ‘do to’ in those with cognitive problems.  The idea that any rehab should be task specific reinforcing the need to know what matters to the person.  Not just what we think matters to them…

This theme continued as the daughters of two of the residents shared their perspective on the care their Mums’ received at Erskine.  They spoke candidly about the good and the not as good. You could tell it was hard to hear but what came across was their appreciation as well as admiration for the work the staff do.

Something that really resonated with me was the comment that ‘I have known my Mum for 56yrs and you have just met her’. I find myself saying something similar when I meet relatives which is why I am such an advocate for the ‘Getting to Know Me’ document.  I have the medical but none of the personal knowledge to help alleviate their loved one’s distress.

Tommy Whitelaw continued to inspire as he spoke about ‘being the one who makes a difference’

The day was summarised for me with Nadine Schofield of ‘Let’s Respect’ when she spoke about the importance of teaching care home staff the 3 D’s

  • Delirium
  • Dementia
  • Depression

Know about them and you’ve pretty much covered all of mental health in older people.

Something may have changed and reality may be to some a distorted nightmare. However on that day I left Erskine with a renewed sense of hope and faith in the goodness of people.








It’s the end of the world as we know it….

The Scream by Edvard Munch, 1893What a week!

For months I’ve been aware of a low grade anxiety bubbling away at the back of my brain.  It would usually come to the fore whenever there was mention of the US election.  Saying that it wasn’t something I gave a great deal of thought to until election day. Sure I had a very visceral response to the news that Donald Trump had been elected.  It also seemed that the universe was conspiring to make it the worst day ever (sprained my ankle, train was cancelled, late to work and snow).

What was interesting to watch was the response on social media especially amongst healthcare professionals. We are well used to dealing with sudden and at times surprising change of events.  It’s what we’re trained to do.  However this week there was a sense that while we were prepared to expect the unexpected, no one was very sure what to do when it actually happened.

There was a great deal of ‘we’re all doomed’ tweets and Facebook posts (admittedly some of which were quite funny). There were also a few ‘I’m only focusing on the things that I can control’

I came across this article which I think does a good job of summarising the past week for many people:


The word ‘acceptance’ has been scored through which I don’t agree with though.  That doesn’t help anyone.

No, by the time Friday rolled around my main feeling was of optimism.  This whole thing was inevitable.  While I don’t think that Trump is the best person to be President I think he is part of a bigger process that will even overshadow him in the end.  Things had to change and I’m not just talking about the USA – look at what has happened the world over in recent years…

So as always there is a choice to be made.  Be paralysed by fear, have a temper tantrum at the injustice of it all.  Or as that well known phrase says ‘Keep calm and carry on’

And carry on we will because there is much to be done.

I returned from the European Delirium Conference focused on making delirium education a priority for all healthcare professionals. However before I could start on that I had an on call to do which also happened to be day one of our frailty pilot.  Instead of seeing every person >75yrs we decided to focus on those we could have the biggest impact on – those with frailty.

More education followed on Tuesday with the ‘Managing Stroke 2016’ event at the RCPSG.

The week finished with a positive meeting with colleagues about the use of Patient Opinion in our Directorate.  Plus my blog was published in the BMJ which not only prompted discussion but encouraged a few to small acts of bravery;


I am naturally an optimistic person.  I will try to see the positive in every situation but I am realistic enough to have plans A – Z in case things don’t work out.  The coming months and years will be at times unpleasant there may even be trouble ahead but as Mr Cole said;

‘…while there’s music and moonlight and love and romance

Let’s face the music and dance’