20 Jun Seniors and Delirium

Seniors are particularly vulnerable to delirium–an altered level of consciousness which causes a state of mental confusion. A medical illness or stressful event–such as a hospitalization usually triggers this condition. In fact, according to the American Delirium Society, almost 7 million Americans who are in the hospital every year experience delirium.

It’s important to note that delirium is different from dementia. Dementia is a permanent neurological condition which begins slowly and progressively worsens over many years. On the other hand, delirium comes on suddenly and will usually go away after a short amount of time. Seniors with dementia can also experience delirium.

Causes

Unfortunately, delirium is sometimes overlooked or completely missed. Family members or even hospital staff may think a senior is slightly confused or exhibiting signs of dementia or “old age.” Consider delirium if an elderly loved one is suddenly confused and is experiencing one or more of the following situations:

• Hospitalization;
• On a ventilator;
• Infections (urinary tract infections in seniors can be a trigger);
• Too much bed rest;
• Physical restraints;
• Catheterization;
• Interrupted sleep (common during a hospital stay).

In addition, different medications seniors already take or new medications prescribed during a hospital stay or emergency room visit can provoke the brain to go into a delirious state. This includes sleep medications (often given in the ICU) which not only make delirium worse but can also lead to increased fall risk among seniors. Furthermore, antihistamines, sometimes prescribed for acute upper respiratory infections, can prompt confusion among seniors.

Seniors who move from their home to any type of long-term care facility can also experience delirium especially for those who are already have some form of dementia. The condition usually subsides after a loved one becomes settled and secure in their new environment which takes about 2 – 3 weeks.

Prevention and Treatment

According to the National Institutes of Health (NIH), approximately a third of patients admitted to an intensive care unit develop delirium. Evidence shows these patients are at increased risk of dying during admission as well as the year after discharge. Delirium also results in longer hospital stays and cognitive impairment after discharge. Hospitals are becoming increasingly aware of the mounting dangers and costs of delirium and are taking preventive measures such as:

• Choosing sedatives which are less likely to trigger confusion;
• Increasing patient exercise earlier in hospital stay;
• Shorter time on ventilator;
• Shorter hospital stay;
• Increasing fluids;
• Limit sleep disruptions.

Treatment involves first treating the underlying cause (such as an infection) and seeing if this resolves a patient’s confusion. As a last resort, antipsychotic medications may be given for a patient’s own safety.

https://www.americandeliriumsociety.org