What is Delirium and How Can it be Prevented?
Sharon K. Inouye, MD, MPH Division of Gerontology, BIDMC Director, Aging Brain Center, Hebrew SeniorLife
DECEMBER 01, 2014
Delirium, or acute confusion, is a sudden change in thinking abilities or the sudden onset of confusion, developing over hours or several days. More than seven million hospitalized Americans suffer from delirium each year.
Although delirium can have long-term effects, it is generally a temporary condition. In contrast, long-term cognitive decline is called dementia. Dementia develops slowly over years and gets worse over time. Delirium is sometimes called “acute brain failure” because of its sudden and dramatic onset.
Delirium causes a person’s mind to become clouded and it becomes difficult to pay attention or focus thoughts. Some people hallucinate or become paranoid because it becomes difficult for them to interpret their environment. Other symptoms may include rambling speech and jumbled thoughts. These symptoms tend to come and go during the course of the day.
Confusion regarding day-to-day events, daily routines, and the roles of familiar people is common. Changes in personality can occur. Some people become quiet and withdrawn while others seem stressed, anxious, or hyperactive.
Delirium may also cause someone to be awake all night and sleep during the day. It may result in altered eating habits. During a delirious episode, some patients do not feel hungry and forget to eat and drink, so caregiver support is important during this time.
Delirium is an especially common and serious problem in hospitalized older patients and requires immediate medical treatment. Delirium can slow the healing or recovery process, leading to more time spent in the hospital.
There are some common causes of delirium that have been identified, such as infections, dehydration, side effects of certain medications, along with other medical conditions. It is important to report a suspected delirious episode so that a medical professional can find the cause and begin treatment. The sooner delirium is identified, the faster it can be treated. With quick treatment, delirium may clear within a few days.
When a loved one is experiencing delirium during a hospitalization, it can be helpful to have a family member or caregiver present at the bedside as much as possible. This will help alleviate some of the anxiety caused by being in an unfamiliar setting. The person with delirium will do best in a quiet setting, but should not be left alone, as this may worsen the confusion. Familiar objects from home (i.e., photos, blanket, bedside clock) can be helpful in an unfamiliar environment. Good (but not harsh) lighting and soothing music are usually beneficial as well. Glasses and hearing aids, if normally worn, should be provided so the patient can see and hear properly, reducing confusion as to what is happening around them.
It is also important to keep the patient mobile and assure that there are no physical restraints used, as that can worsen the confusion. Walking with the patient can be a key factor in making sure he or she has the best recovery possible. Making sure the patient eats and drinks is also crucial.
It is important to talk to the patient about the delirious episode. Patients are often aware that they have experienced an episode of confusion and would like to talk it through with people they trust. They may recall the episode as a confusing dream that they had, or not recall anything. Healthcare professionals, including doctors, nurses, and licensed psychologists involved in the patient’s care, may also be able to provide helpful advice. Discussing the experience with the patient can help to alleviate the anxiety, fear, frustration, or anger that might otherwise develop.
There are several ways to prevent delirium by addressing delirium risk factors. The Hospital Elder Life Program (HELP) is an innovative model of hospital care designed to prevent delirium and functional decline among elderly individuals in the hospital inpatient setting. HELP uses interdisciplinary staff and targeted intervention protocols to improve patients' outcomes and provide cost-effective care. The primary goals of the program are to maintain the cognitive and physical functioning of high risk older adults throughout hospitalization, maximize independence at discharge, and prevent unplanned hospital readmissions.
Above content provided by Hebrew SeniorLife in partnership with Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
December 2014