For Seniors, Delirium Is a Hospital Hazard

Is your loved one going to the hospital? Learn the symptoms of delirium so you can alert staff if needed.

Senior man in the hospital

Dad's surgery was a success. But when family came to visit, they were startled to hear him shouting, "I need to go to the hospital now!" "Dad," said his son, "You are in the hospital." Dad became agitated and said, "You're making things up!" Then he fell asleep. A nurse asked if Dad suffered from dementia; family assured her he did not. She said Dad was most likely experiencing delirium.

Delirium is a sudden, temporary change in thinking and function that causes confusion, delusions and hallucinations. People with delirium may sometimes be very agitated, and other times lethargic and sleepy. They may not know where they are, and they may not even recognize family and friends. They may have vivid nightmares and incontinence. It can be very upsetting to see your loved one in that condition, report families.

Dr. Marie A. Bernard, deputy director of the National Institute on Aging, said that the causes of delirium aren't entirely understood. People of any age can experience delirium when they have an illness or infection or take certain medications. But it's most common among older adults, especially in the hospital setting. Explained Dr. Bernard, "In the hospital, you get lots of different medications that can interact and affect the brain, and you're also off your normal schedule—frequently awakened, for example, for blood pressure readings and other needs, and that lack of sleep can contribute to delirium. Put all those factors together and it puts one at particular risk for developing delirium."

Delirium is usually short-term and temporary. But not always. It may be weeks or even months before a senior patient makes a full recovery. Medical professionals once thought that delirium was completely reversible. But now, it's known that delirium can hasten the progression of dementia, and can place patients at higher risk of falls, nursing home placement, and even death.

Preventing delirium

Recognizing the negative impacts from hospital delirium, hospitals are working to find solutions. Those include:

Environmental changes. The American Delirium Society's Dr. James Rudolph recommended that hospitals create a less stressful healing environment that does not overload the brains of patients, and that patients receive sedative medications only when necessary. Researchers recommend preventive measures such as improving nutrition and hydration, ensuring an uninterrupted night's sleep, daily exercise, mental stimulation, and reality orientation activities. More hospitals today have designated wards or protocols for older patients, with the input of geriatricians.

Identification of at-risk patients. Dr. Sharon K. Inouye of Harvard Medical School reported that up to 40 percent of delirium episodes are preventable. She described precautionary measures that include a careful evaluation of the patient's medications, treating infection if present, and ensuring adequate oxygen levels. Blood tests can be used to determine which patients are at higher risk.

Quick diagnosis. Dr. Rudolph said, "Most importantly, we need to make sure we are alert to signs of delirium and address it as soon as possible." But this isn't always easy. The National Institute on Aging reports that fewer than half of dementia cases are properly diagnosed. Hospital personnel may mistake agitation for dementia, or lethargy for depression. They might think a patient is just sleepy, which isn't uncommon after illness or injury.

Who is best qualified to spot the signs of delirium?

The hospital is full of experts—and these experts usually know that when it comes to recognizing signs of delirium, family and friends are the real experts! Families know their loved one's "normal," and can report any personality or mental changes right away. Sometimes it's obvious that a patient is having trouble—they might try to pull out their IV or become combative with staff. But the signs can be more subtle. Maybe you've had the experience of coming out of anesthesia, making a silly joke, and having the nurse ask the person who brought you to the hospital if that's normal for you?

For hospitalized seniors, family are valuable advocates. Speak up if you're concerned. Stay on the scene—your presence will help your loved one remain calm and oriented. If your loved one can't understand instructions, step in. Explain to other visitors what's going on. Help your loved one stay hydrated if advised to do so. Be sure your loved one has their eyeglasses and hearing aids to help them stay in touch with reality. Experts say mental stimulation keeps patients oriented, so talk to your loved one. Play word games. Play music. Watch something on TV and chat about it.

Even after discharge, families help senior patients to be safe at home, comply with rehabilitation goals and manage medications. In-home care services can help. To learn more, visit the Right at Home Care Transitions web page.

Right at Home caregiver with client

Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.