Alice Verran is a second year Foundation doctor at Croydon University Hospital; in this blog she reports back from the recent BGS / EDA meeting on delirium.
A conference jointly hosted by the European Delirium Association and the British Geriatric Society; the perfect union of experts and professionals with an interest in delirium. Not just discussions about delirium in the elderly, but a host of talks on delirium in other contexts such as children in ITU and alcohol withdrawal.
Professor Rockwood began Thursday’s plenary by demonstrating how frailty is associated with an increased risk of delirium, formulating it as “the at-risk brain in an at-risk body”.
It was interesting to see how mortality was related to subtype of delirium, indicating perhaps more should be done to classify it clinically. This was followed by Rowan Harwood’s talk on the problems encountered conducting trials in delirium. From the practical aspects, to recruiting the right patients, to issues with power and heterogeneity (different subtypes, the cause, the presence of underlying dementia….), to the difficulties finding funding for this hidden health problem. It would seem prevention rather than treatment is our best available option.
Friday began with Andrew Teodorczuk’s thoughts on cultural barriers that prevent the recognition of delirium. He highlighted the attitudes of staff (eg avoiding a delirious patient or negative attitudes towards them), a lack of personal responsibility and the lack of system report. Suggestions to improve included inter-professional education, promotion of ownership and reshaping activities so that delirium is included in our early warning scores.
There were plenty of lectures on the science behind delirium and it was fascinating to see the work that is going on in the background, seemingly so far removed from the day-to-day clinical work but with huge potential to drastically change clinical practice (or at least help understand it!).
Perhaps my favourite talk was Jose Maldonado’s discussion of innovations in the care of patients withdrawing from alcohol. He makes a convincing argument against the widely accepted use of benzodiazepines (abuse potential, increased cravings and side-effects) and argues that alpha-2 blockers like clonidine, which prevent the sympathetic overactivity, along with anti-epileptics are just as effective. There have been no incidences of DTs since his alcohol withdrawal protocol was implemented at Stanford Hospital several years ago.