By Jennifer Beach, LSW, MA, C-SWCM
My mom had a host of physical challenges at too early of an age and died at only 76 years old. By her late 60s, she had had a total of five hip replacements (two on each side due to chronic osteoarthritis; the prosthetics available at the time and the last one due to a fall). By 70 she was diagnosed with Parkinson’s disease and several years later, melanoma spread to her lymph nodes very quickly, just to highlight a few of her challenges.
At around age 72, she had what was to be a standard outpatient biopsy on her liver but this resulted in a renal artery being accidentally nicked during the process. It was discovered later that night at home, she was bleeding internally and soon was in ICU for several weeks. She developed delirium and, at the time, our family was completely unaware of nor understood what delirium was, what to do or what to expect. Many years later, working as an Aging Life Care Professional, I have seen many older adults experience delirium and have learned more and more about this condition.
Delirium is a temporary state of mental confusion that starts suddenly. It is caused by a physical condition of some sort, such as an infection. The most common causes of delirium include infections, dehydration or low salt levels, and liver and kidney problems.
Someone suffering from delirium might not know where they are, what time it is, or what’s happening to them.
Many people believe it is normal for older people in hospital to be confused, but this misconception contributes to the fact about two-thirds of delirium cases are misdiagnosed. In fact, although older people are at higher risk, delirium can affect anyone at any age.
People who are at higher risk of delirium include those over 65 years old, who have dementia, poor hearing or vision or have multiple medical conditions, or who are taking multiple medications.
It is important for everyone to know the signs of delirium. Common signs:
- Confusion
- Frequent mood swings
- Memory loss, including forgetting recent events or family members’ names
- Sudden changes in personality or emotional state
- Decreased attention or concentration
- Periods of alertness that come and go throughout the day
- Hallucinations (seeing or hearing things that are not there)
- Insomnia and changes in usual sleep patterns
- Slower movements or unusually restless movements
- Changes in speech, such as saying things that don’t make sense
If you are worried that your loved one’s behavior has changed suddenly (for example they seem sleepier, more agitated, more confused, or can’t follow conversations), please THINK DELIRIUM and mention delirium to the medical team.
When possible, a few important things you can do to help your loved one prevent and treat the delirium:
- Stay with the person in the hospital as much as possible. Having a familiar face(s ) present will provides comfort and familiarity. Also, you can help encourage and ensure they are getting liquids, assist with meals and provide conversation and comfort. Be sensitive to the number of people, or stimulation going on. Creating a calm environment is best.
- If they have hearing aid, glasses and/or dentures, be sure they have them. Often, people take these home for fear of being lost or hospital staff does not have time to assist them. This can add to the sense of disorientation and a diminished ability to function.
- Have a clock visible, if possible, let light in during the day, close blinds at night, encourage sitting up, eating three meals a day, create as much of a “normal” routine as possible to help keep a rhythm to the day.
Treatment of delirium starts with finding the underlying cause and treating this (for example, giving antibiotics to treat an infection) and can be reversed over time. Common causes of delirium are:
- Starting new medications or changing current medication doses
- Stopping medications that the person has been on for a long time
- Stopping regular use of alcohol or sleeping pills
- Pain that is not treated well
- Constipation
- Thyroid problems
- Infections, especially of the lungs or urinary tract
- Not getting enough liquids (dehydration)
- Stroke
- Heart problems, including heart failure and irregular heart rhythms
As my mom slowly began to recover from blood loss, was treated for an infection, and finally was moved to a room with a window, the delirium started to subside, and she started to slowly return to normal. With older adults or with mom’s critical condition, it can take months to completely disappear. I wish we had been aware of what was happening, what to do and what questions to ask. It can be very frightening to see a loved one so disoriented, but typically, delirium will go away with treatment and support.
Original Article: https://www.northeastohioboomer.com/blogs/delirium-in-older-adults/