Why Delirium Is Such An Important Problem
There are three major reasons why delirium is an important problem for us all to prevent, detect, and manage.
First, delirium is a sign of illness or stress on the body and mind. So if a person becomes delirious, its important to identify the underlying problems such as an infection or untreated pain and correct them, so that the person can heal and improve.
The second reason delirium is important is that a confused person is at higher risk for falls and injuries during the period of delirium.
The third reason is that delirium often causes serious consequences related to health and well-being.
In the short-term, delirium increases the length of hospital stays, and has been linked to a higher chance of dying during hospitalization. In the longer-term, delirium has been linked toworse health outcomes, such as declines in independence, and even acceleration of cognitive decline.
Now lets cover 10 more important facts you should know about delirium, especially if youre concerned about an aging parent or other older relative.
Things To Know About Delirium And What You Can Do
1.Delirium is extremely common in aging adults.
Almost a third of adults aged 65 and older experience delirium at some point during a hospitalization, with delirium being even more common in the intensive care unit, where its been found to affect 70% of patients. Delirium is also common in rehabilitation units, with one study finding that 16% of patients were experiencing delirium.
Delirium is less common in the outpatient setting . But it still can occur when an older adults gets sick or is affected by medications, especially if the person has a dementia such as Alzheimers.
What to do: Learn about delirium, so that you can help your parent reduce the risk, get help quickly if needed, and better understand what to expect if your parent does develop delirium. You should be especially be prepared to spot delirium if your parent or loved one is hospitalized, or has a dementia diagnosis. Dont assume this is a rare problem that probably wont affect your family. For more on hospital delirium, see Hospital Delirium: What to know & do.
2. Delirium can make a person quieter.
What to do: Be alert to those signs of difficulty focusing and worse-than-usual confusion, even if your parent seems quiet and isnt agitated. Tell the hospital staff if you think your parent may be having hypoactive delirium. In the hospital, its normal for older patients to be tired. Itsnotnormal for them to have a lot more difficulty than usual making sense of what you say to them.
What Is The Outlook For People With Delirium
Patients can recover completely if the cause of delirium is identified quickly and addressed. Any delay makes it less likely theyll recover quickly and/or fully. Lack of treatment can lead to stupor, coma or even death. Older persons with dementia and those with HIV are less likely to have a complete recovery.
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Dementia Vs Delirium: Key Differences
When it comes to these separate cognitive conditions, it’s important to realize that an individual can experience both at the same time. For example, if your loved one has Alzheimer’s disease but then experiences an episode of extreme hallucinations, radical mood changes, and unusual confusion and disorientation, then they may need to seek medical treatment for delirium.
However, in general, here are the key differences to look out for:
- Memory: One of the major differences between delirium and dementia is that, while delirium affects attention and concentration, dementia is primarily associated with memory loss.
- Attention: Though seniors with dementia may have some issues with attention in the late stages of the condition, for the most part, they are able to remain relatively attentive. By contrast, individuals in a state of delirium will be easily distracted, unable to concentrate, and generally going in and out of consciousness.
- Speech: Although individuals with dementia in late stages may have difficulty putting their thoughts to words, they usually won’t demonstrate the sudden slurred speech common to delirium.
- Hallucinations: Though hallucinations occasionally occur with dementia, they are very common with delirium.
- Illness: Delirium is often caused by illness, surgery, or drugs. Those with dementia often will have no signs of physical illness or conditions.
Memory Impairment And Disorientation
Memory deficits, especially where recent events are concerned , are also prominent in patients with delirium. Patients may report not being bathed or bedding not being changed when, in fact, these events occurred earlier in the day. Disorientation to date, place, and situation is common. However, the latter can go unrecognized if patients are not directly asked for the information. For example, hospital staff and family members may assume that a patient is fully oriented only to be surprised when the patient insists that he or she is at home and that the date is 10 years earlier.
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Delirium In People With Dementia
Distinguishing between delirium or dementia is important however, a more difficult task may be identifying delirium in someone who already has dementia. According to a study by Fick and Flanagan, approximately 22% of older adults in the community with dementia develop delirium. However, that rate skyrockets to 89% for those who have dementia and are hospitalized.
Knowing how to identify delirium in someone who is already confused is critical for appropriate treatment and a faster recovery. Delirium superimposed on someone with dementia also is connected with a more than double mortality risk compared to those with delirium or dementia alone.
Why It’s More Common After Surgery
Delirium is seen more frequently in surgery patients than the general population of the hospital for multiple reasons. These patients tend to be sicker than average, they receive anesthesia medications that can contribute to delirium, they may have a longer hospital stay, and may receive pain medications during their recovery and other drugs that can worsen delirium.
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Msd And The Msd Manuals
Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in 1899 as a service to the community. The legacy of this great resource continues as the MSD Manual outside of the United States and Canada. Learn more about our commitment to Global Medical Knowledge.
How To Help A Person With Delirium
There are many ways you can help a person with delirium. You can help them by:
- Encouraging them to rest and sleep.
- Keeping their room quiet and calm.
- Making sure theyre comfortable.
- Encouraging them to get up and sit in a chair during the day.
- Encouraging them to work with a physical or occupational therapist.
- A physical therapist can help them move around and get out of bed.
- An occupational therapist can help them do daily tasks to take care of themselves and show them mental exercises they can do .
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Delirium In The Elderly
Delirium means “sudden confusion,” and reflects a serious disturbance in thought, mood, and behavior. All of the sudden, your loved one may no longer behave like themselves and you may not immediately recognize the cause. Some common signs that indicate an episode of delirium include:
- Mood changes: Anger, agitation, anxiety, depression, suspicion, and fear are all common in delirium
- Changes in speech: Your loved one may have slurred speech or suddenly start saying things that make no sense
- Sleep changes: Seniors may become more active at night or sleepy during the day
- Disorientation and confusion: A senior might not know where they are or what they are doing
- Visual hallucinations: Your loved one may report seeing things that aren’t there
- Physical issues: They may report incontinence, chills, fever, or pain
If these signs and symptoms come about over the course of a few days or hours, then it’s important to seek medical treatment immediately.
Is Delirium The Same As Dementia
Delirium and dementia have some similarities, but they are not the same.
- Delirium mostly affects a persons attention. Dementia affects memory.
- Delirium is a temporary state that begins suddenly. Dementia is chronic confusion that usually begins gradually and worsens over time.
However, someone can have both delirium and dementia. Seek care quickly if a person, especially one with dementia, begins to show symptoms of delirium.
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Search Strategy And Selection Criteria
We conducted an initial systematic search of Medline, Ovid SP, Embase, and Science Citation Index from 1950-2012. The Ovid search terms included âexp Delirium/ep ââdelirium.mpââacute confusionâ.mp âmetabolic encephalopathyâ.mp, with equivalent terms used in the other databases. There were no language restrictions. Articles were selected by hand-review of the results of the search on the basis of relevance to delirium and dementia. Subsequently, an updated systematic search was conducted in PubMed from 2000 â 2015 using the following search strategy: AND . For all articles, including systematic and comprehensive reviews, tables and reference listings generated were reviewed for additional pertinent articles.
How To Prevent Hospital Delirium
Now, not all hospital delirium can be prevented. Some people are very sick, or very prone to delirium, and its certainly possible to develop delirium even when all triggers and risk factors have been addressed. Furthermore, many older adults are already delirious when they first get hospitalized.
Still, there are steps that can be taken to reduce the chance of a bad delirium. Experts estimate that about 40% of delirium cases are preventable.
The ideal is to be hospitalized in a facility that has already set up a multi-disciplinary delirium prevention approach, such as the Hospital Elder Life Program. Other hospitals have Acute Care for Elders units which also provide a special environment meant to minimize the hospital stressors that can tip an older person into delirium.
For elective surgeries, such as joint replacements, look for a hospital that has set up a geriatric co-management program for orthopedics, such as this one.
Here are some specific interventions that help reduce delirium, and how you can help as a caregiver:
- Minimize sleep deprivation. Consider asking the nurses if its possible to avoid blood pressure checks in the middle of the night. A quieter room can help. Do NOT ask for sleeping pills, however! Even a mild sedative, such as diphenhydramine increases the risk of developing delirium. Sleeping pills can also make delirium worse in someone who is already affected.
For more useful ideas, see this family tip sheet from the Hospital Elder Life Program.
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What Are The Causes Of Delirium
Delirium can be caused by changes in a person’s health, such as an infection or a medication change. It can also be caused by things such as constipation, dehydration and pain. Many people will have more than one problem leading to their delirium. Sometimes it is difficult to find the cause.
People with dementia, cognitive impairment, or hearing or vision loss are at an increased risk of delirium.
Evidence Linking Delirium And Dementia
A major area of controversy is whether delirium is simply a marker of vulnerability to dementia, whether delirium unmasks unrecognised dementia, whether the impact of delirium is solely related to its precipitating factors, or whether delirium itself can cause permanent neuronal damage and lead to dementia. Clinically, the development of delirium may have direct âtoxicâ effects related to periods of lethargy, psychomotor retardation or agitation, and unsafe behaviours. The lethargy and psychomotor retardation may result in immobility and related complications, including but not limited to aspiration pneumonia, respiratory compromise, decreased oral intake with dehydration or malnutrition, pressure ulcers, urinary tract infection, deep venous thrombosis and pulmonary emboli. Psychomotor agitation and unsafe behaviour may lead to falls and use of antipsychotics and other sedative medications or physical restraints, along with their attendant complications. Thus, the occurrence of delirium itself may set off a cascade of noxious stimuli that may adversely impact the brain.
Ref.
Maclullich AM, Anand A, Davis DH, Jackson T, Barugh AJ, Hall RJ, Ferguson KJ, Meagher DJ, Cunningham C. New horizons in the pathogenesis, assessment and management of delirium. Age Ageing. 2013 Nov 42:667-74.
Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol 2009 5: 210-220. PMCID: PMC3065676
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Delirium Vs Dementia: What’s The Difference
When it comes to ensuring that your loved one receives the absolute best in support and services, it’s crucial to understand that cognitive changes, like delirium and dementia, require just as much care as physical conditions, like heart disease and high blood pressure.
Cognitive issues can affect a senior’s ability to think, reason, or remember and become much more common as we age. In fact, around one-third of seniors who arrive at hospital emergency rooms are found to be suffering an episode of delirium. And 1 in 6 women and 1 in 10 men past the age of 55 will go on to develop dementia.
To best support your loved one, it’s important to know how to identify both delirium and dementia. What are the signs and symptoms? What causes these cognitive issues? And how are these conditions different? Let’s take a closer look at delirium vs. dementia in seniors.
Providing Support For Cognitive Issues
As a loved one or caregiver, you can make all the difference by noticing any changes in your loved one’s thinking, reasoning, or behavior. If your loved one’s memory and judgment seem to be deteriorating over time, then it might indicate the progressive cognitive decline associated with dementia. In these cases, it’s important to know when to seek professional care for your loved one.
If, however, your loved one experiences a sudden onset of confusion at home, in the hospital, or after surgery then it’s important to alert emergency medical professionals right away. Want to learn more about how to help your loved one remain safe and healthy? Please don’t hesitate to contact us today.
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What Side Effects Do Delirium Treatments Have
Antipsychotic drugs come with some side effects, although researchers are working on developing drugs that cause fewer side effects. Side effects are more common in older adults and can include:
- High illness and death rates.
- Stroke.
- High-than-normal pulse rate with irregular heartbeats .
Benzodiazepines can cause:
Attention Span And Memory
Dementia: A person’s level of alertness is typically not affected until the late stages of Alzheimer’s, whereas memory is significantly affected throughout the disease.
Delirium: In delirium, the opposite is true. Memory functioning is usually less affected in delirium but the ability to focus and maintain attention to something or someone is very poor.
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What Is The Difference Between Delirium And Dementia
Both delirium and dementia have similar symptoms, but the two medical conditions are not the same. Delirium usually comes on suddenly, and there are ways to prevent it from developing. The onset of dementia is slower, usually taking months or years to develop with minor symptoms sometimes being dismissed as normal forgetfulness or ignored. With this information, you should be able to tell the differences between delirium vs dementia and understand why awareness of delirium and its causes is important.
Some memory lapses are a natural part of aging, but when it is combined with confusion, disorientation, difficulty concentrating, or speech problems, then there is a reason for concern. Since these symptoms can indicate more than one medical condition, an appointment with a doctor should be made to diagnose the condition.
Differentiating Dementia Delirium And Depression
13 April, 2015By NT Contributor
How can you tell the difference between dementia, delirium and depression in older people, to ensure they receive the right care? Current knowledge on this question is summarised in this article, and is also available as a learning resource in our learning unit on dementia, delirium and depression
Citation: Polson J et al Differentiating dementia, delirium and depression. Nursing Times 111: 16, 19.
Jilly Polson and Suzanne Croy are dementia lead associates, Dementia Services Development Centre, University of Stirling.
- Scroll down to read the article or
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How Is Delirium Treated
The doctor may request blood and urine tests and will be able to decide on appropriate treatment. They may also want to review any medication that could be contributing to the delirium.
There is also evidence that delirium can be prevented by targeting potential causes. You can mitigate against some of the causes of the confusion, like constipation, dehydration and infection, by ensuring the person stays well hydrated, observes hand hygiene and follows any advice theyre given about wound care and medical devices . If possible, you should also avoid the person moving beds or wards in hospital.
Identifying Underlying Medical Conditions
The definitive treatment for delirium is to correct the underlying medical condition causing the disorder. The initial steps in managing patients with delirium are to conduct a careful review of the medical history, physical examination findings, laboratory evaluations, and any drugs the patient is using, including over-the-counter agents, illicit drugs, and alcohol. Information from patients current and past medical history, as well as the physical examination, should guide the initial work-up. Often the etiology will be fairly obvious from the history and basic laboratory tests.13 Table 66,14 outlines a plan for assessing patients with delirium.
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