Ms. Archambault is a social worker in the Department of Geriatrics and Palliative Care; Ms. Doherty and Ms. Kelly served as research assistants within the Geriatric Research Education and Clinical Center at the time the article was written; Ms. Doherty is currently a research assistant, all at the VA Boston Healthcare System in West Roxbury, Massachusetts. Dr. Rudolph is the director of the Center of Innovation in Long-Term Services and Supports at the Providence VA Medical Center in Rhode Island. Ms. Kelly is currently working as a nurse and completing her training as a nurse practitioner candidate.
Social workers are skilled at helping individuals feel more at ease when disclosing distressing experiences. Delirium is relevant to HCPs and hospital social workers with care transition responsibilities, because delirium detection should impact discharge planning. 1,39 Delirium education needs to be included in efforts to improve transitions from intensive care settings to lower levels of care and from lower levels of care to discharge. 40 Hospital social workers are in a position to offer additional support because they see patients at a critical juncture in their care and can take steps to improve postdischarge outcomes. 41
Prior to Onset
Social workers can play an important role prior to delirium onset. 42 Patient education on delirium needs to be provided during the routine hospital intake assessment. Informing patients in advance that delirium is common, based on their risk factors, as well as what to expect if delirium is experienced has been found to provide comfort. 38 Families who anticipated possible delirium-related confusion reported that they experienced less distress. 38
During hospitalization, social workers can ascertain from families whether an alteration in mental status is a rapid change, possibly indicating delirium, or a gradual dementia onset. The social work skills of advocacy and education can be used to support delirium-risk identification to avoid adverse outcomes.43 When no family caregiver is present to provide a history of the individual’s cognitive function prior to hospitalization, the social worker may be the first to notice an acute change in cognitive status and can report this to the medical team.
During Delirium
Lack of patient responsiveness and difficulty following a conversation are possible signs of delirium. This situation should be reported to the medical team for further delirium assessment and diagnosis. 4 The social worker can also attempt to determine whether a patient’s presentation is unusual by contacting the family. Social work training recognizes the important role of the family. 44 Social workers often interact with families at the critical period between acute onset of delirium in the hospital and discharge. 42 Studies have shown that delirium causes stress for the patient’s loved ones. Moreover, caregivers of patients who experience the syndrome are at a 12 times increased risk of meeting the criteria for generalized anxiety disorder. 30 In one study, delirium was rated as more distressing for the caregivers who witnessed it than for the patients who experienced it. 38 Education has been shown to reduce delirium-related distress. 30
In cases where delirium is irreversible, such as during the active dying process, social workers can serve in a palliative role to ease family confusion and provide comfort. 30 The presence of family and other familiar people are considered part of the nonpharmacologic management of delirium. 28
Posthospitalization
Delirium complicates physical aspects of care for families, as their loved one may need direct care in areas where they were previously independent due to a loss of function. Logistic considerations such as increased supervision may be necessary due to delirium, and the patient’s condition may be upsetting and confusing for family members, triggering the need for emotional support. During the discharge process, social workers can provide support and education to family members or placement facilities. 38
