Knowing a patient's cognitive baseline helps detect changes that may signal acute deterioration, such as delirium, and supports timely assessment and intervention.
Cognitive impairment
For patients living with dementia or other cognitive impairments, tailor care to their needs, abilities, and preferences. Family members and carers can tell you about the patient’s:
- usual routines, to tailor care
- communication style and preferences
- patterns of behaviour, to anticipate risks
- triggers for distress or anxiety
- strategies that comfort, reassure, and de-escalate.
Individualised behaviour support plans can help patients with advanced dementia or significant cognitive impairment. They promote a consistent approach to care and support the management of behaviours that may place the patient or others at risk of harm.
Check the patient’s capacity
Check whether the patient can understand information, follow instructions, make decisions, and use safety tools such as a call bell. If they cannot, put other measures in place to keep them safe, such as increased observation, intentional rounding, changes to the environment or extra help from family, carers, or staff.
Delirium
Delirium is a serious, often under-recognised medical condition. It is linked to more complications, longer hospital stays and higher mortality. It can affect patients of any age but is more common in older people.
Identifying delirium
Delirium is an acute change in mental status that:
- develops over a short period of time, usually hours to a few days
- is commonly triggered by acute illness, surgery, injury, infection, or certain medications
- affects attention, awareness, thinking, memory, and perception
- often fluctuates throughout the day.
Patients with hyperactive delirium may appear restless, agitated, or distressed. Others may experience hypoactive delirium and become quiet, withdrawn, or drowsy. Some patients can experience both (mixed delirium).
Delirium is sometimes mistaken for dementia. Delirium develops suddenly and is characterised by changes in attention and level of consciousness. Dementia usually develops gradually over time.
Recognise and manage delirium
Recognise and manage delirium early. If you suspect or identify delirium, escalate it to the medical team straight away for assessment and treatment.
Use the 4AT to screen for delirium and cognitive impairment and support the prevention and management of delirium by implementing an individualised comprehensive care plan. The Delirium Clinical Care Standard from the Australian Commission on Safety and Quality Health Care sets out specific strategies.