Editorial: Delirium

Abstract

The papers in this practice development section tackle an important but often overlooked health problem in older age, the occurrence of delirium. As the first paper shows, delirium can have a major impact on older people, leading to disorientation and increased morbidity and mortality. While older people are at increased risk of having delirium, the condition can be difficult to distinguish from dementia and depression, and indeed some of the assumptions that are made about older people, that they are usually confused and unable to cope with daily life. These assumptions can lead to a lack of awareness and understanding of delirium. This is important, because a failure to understand the problem can lead to a failure to identify and respond to it, and the second paper in the PD section focuses on the nursing response to delirium. Interestingly Stephen Neville uses qualitative methodology to explore discourses of delirium, and identified two, a nursing narrative and another from people who have experienced their own delirium. While nurses present a narrative with an emphasis on biomedical factors, older people who have had delirium tell a different story, one that includes and embraces the social dimension, the dynamics of the relationships that they are engaged in, and the way that delirium takes place in this context. The bringing together of these discourses promises a more holistic approach, and one which offers a relevant way of understanding and responding to delirium. The concluding paper in this section takes up this point, and explores ways in which understandings of delirium might be taken forward. Kate Irving and Marquis Foreman points to the growing body of research knowledge in this area, but it is clear that practice development can draw on much more than this. While technical or scientific knowledge may be developing, understandings from practice experience and discussion with older people and their families can form a strong basis for practice. This basis, however, needs some support to develop, support for talking to older people and reflecting on practice, in ways that will open up this knowledge to use and understanding. These issues, about the type and nature of nursing knowledge and the ways in which it can be used, resonate with many of the issues discussed in the other section of this issue, where the points were made that much can be learned through asking older people about their experiences, and their answers can inform nursing practice. Also common across these sections, however, is the barrier of assumptions about older people, that their care is unskilled and of low priority, and that their reflections on their needs can be dismissed, or at least not actively sought. With this specific example of delirium, this practice development section offers an in-depth exploration of these issues, in an important and complex area.