Did you know that delirium affects almost 7 million hospitalized patients every year? The costs of this often-undiagnosed illness are steep, especially when you factor in longer hospital stays and an increase in mortality after discharge. But what is delirium exactly? And can it be prevented? Let’s take a look at this condition, and why it has certain implications for those in senior care.
What is delirium?
According to the Mayo Clinic, “Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of your environment. The start of delirium is usually rapid — within hours or a few days. Because symptoms of delirium and dementia can be similar, input from a family member or caregiver may be important for a doctor to make an accurate diagnosis.”
How do you know if a loved one is being affected by delirium? Some of the warning signs to look for are:
- changes in behavior (whether aggressive, withdrawn, belligerent, anxious, or something else)
- the person seems to be hallucinating or experiencing flashbacks
- sleepiness or lethargy
- confusion and/or disorientation
Be especially aware of these signs if a senior has recently had surgery or an extended hospital stay. One of the reasons delirium can be so serious is that cognitive and behavioral functions may or may not return to normal after a bout with it. As mentioned above, it can be easy to mix up dementia and delirium. Here is what the Mayo Clinic has to say about the two:
“Onset. The onset of delirium occurs within a short time, while dementia usually begins with relatively minor symptoms that gradually worsen over time. Attention. The ability to stay focused or maintain attention is significantly impaired with delirium. A person in the early stages of dementia remains generally alert. Fluctuation. The appearance of delirium symptoms can fluctuate significantly and frequently throughout the day. While people with dementia have better and worse times of day, their memory and thinking skills stay at a fairly constant level during the course of a day.”
What causes delirium?
While delirium can affect almost anyone, there are some factors that result in a greater likelihood of getting it, such as extended hospitalization post-surgery. Why would an extended hospital stay have negative effects on a person’s health? Some of the theories being put forward posit that the unnatural setting, bright lights, interrupted sleep, lack of nature, decreased mobility, and unfamiliar faces can all contribute to a patient’s risk of becoming delirious. Other contributing factors might be changes in metabolic balance (like a vitamin deficiency, low sodium, etc), certain medications, a previous cognitive impairment, or going through drug or alcohol withdrawal. Primary caretakers who recognize more than one of these factors in a loved one or patient should be especially aware of delirium risk.
Is it possible to prevent delirium?
The study of delirium has not gotten much attention in modern times, but thankfully, there have been doctors who have spearheaded research in this area. One of them, Dr Sharon Inouye, has studied the phenomenon since the 1980s. She has since started the Hospital Elder Life Program (HELP), which aims to help seniors and other patients avoid delirium. Here are some tips from the program (compiled by the Society of Certified Senior Advisors):
- Vision and hearing. Our senses connect us to the outside world and are essential for good communication and safe movement. If you use glasses and/or hearing aids, bring them with you to the hospital.
- Hydration. All body systems need water to function. Unless instructed otherwise by a healthcare provider, adults should consume 8 cups of plain water each day.
- Toileting. Adults should use the toilet every two to three hours. Don’t wait until the need is urgent.
- Mobility. Try to stand-up and walk around your room, unless your nurse or doctor has told you that you should stay in bed. If you are able, move around even when you are lying or sitting in bed. For example, make circles with your ankles, clench and release your fists, and wiggle your toes.
- Medicine. When you go to the hospital, bring an up-to-date list of all medications you take regularly, including over-the-counter medications and dietary supplements.
How can in home care benefit those suffering from delirium?
According to various doctors, hospitals, and other healthcare organizations, older people living in a long term care facility or recovering from surgery in the hospital are at a higher risk of developing delirium. For this reason, it can be preferable to hire in home care, so that your loved one is in a familiar environment with familiar faces and can keep somewhat of a normal routine. It’s especially beneficial when the primary caretakers have Registered Nurse supervision and extensive training; they will be more attuned to pick up on signs of delirium. Of course, you may be wondering whether in home care is unreasonably expensive or whether it’s realistic for your family...learn more about the costs of various types of senior care here.
At Pennsylvania Agency of Nurses, we take great pride in our ability to care for family members with competence, compassion, and skill. If you or a loved one need assistance or are at risk for developing delirium, please contact us to see if we’re a good fit for your situation and your family. You maintain control, we absorb the stress!