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1. Background
2. Identify
3. Causes
4. Symptoms
5. Care strategies
6. Document information

Background

Delirium can be a feature of COVID-19. Delirium is a common and serious medical problem that is characterised by changes in mental and physical function.

Identify

Screen all patients with suspected or confirmed COVID-19, and repeat if there is a change or fluctuation in cognition, behaviour or function, using the following tools:

On eMR

• Abbreviated Mental Test Score (AMTS)
• Confusion Assessment Method (CAM)

Where a paper form is in use

4AT

Causes

Delirium is often associated with an underlying illness or infection, including COVID-19. Other common causes of delirium, which should be managed and prevented, include:

• medications/polypharmacy
• constipation or urinary retention
• dehydration or malnutrition
• pain
• sleep disturbance
• urinary tract infection (UTI)
• withdrawal from alcohol, cigarettes or medication and in particular sedatives
• changes in a person’s environment, such as being hospitalised or the introduction of noise, temperature, medical devices or physical restraints
• surgery and anaesthetic.

Symptoms

Symptoms of delirium occur suddenly, fluctuate and involve changes to a person’s behaviour, cognition, consciousness and/or functional ability. The person may:

• act differently from their usual self
• appear inattentive, disoriented, vague or forgetful
• be drowsy, lethargic, withdrawn, agitated, restless or aggressive
• feel fearful, upset, irritable, angry or sad
• experience hallucinations or delusions that seem very real to them
• experience changes to sleeping habits like remaining awake at night and drowsy during day
• have reduced function that may include falls, mobility and ability to self-care
• have new incontinence.

Care strategies

Implement the following care strategies:

• Gain the person’s attention before any interaction.
• Remain calm and speak slowly in a clear voice, identify yourself and address the person by their name.
• If the person usually wears glasses or hearing aids, ensure they are on and working.
• Proactive rounding, including the five Ps (pee, poo, pus, pain and pills).
• Regularly assess and manage pain.
• Encourage and assist with eating, drinking, mobility, toileting and monitor bowels. Maintain adequate hydration.
• Orientate using location, date and time and utilise visual cues like clocks and calendars.
• Ensure lighting is appropriate to the time of day. eg. make sure blinds are open during day and encourage normal sleep pattern.
• Engage in meaningful conversations and activities.
• Encourage communication with family/carers via voice or video call
• Avoid arguing with the person and provide reassurance.

Pharmacological treatment may be considered if a person remains distressed or is at risk to themselves or others. Refer to local policies for guidance.

Document information

Developed by

Aged care / Aged health community of practice.

Consultation

Consulted with medical, nursing and allied health clinicians with expertise managing delirium.

Endorsed by

Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.

For use by

Clinicians with delirium management in the COVID-19 pandemic.

Feedback

Feedback on this document can be provided to MOH-COVID-19AgedCareCOP@health.nsw.gov.au​​