Can Hospital Delirium Be Prevented?

Delirium is a temporary condition that often happens to older people when they are ill. It causes the person to be confused, and usually has a rapid onset, within hours or a few days. People recovering from surgery or an illness in hospital or a long-term care facility, are particularly at risk. If delirium occurs in the hospital, it often goes undiagnosed, or medical notes will simply refer to the person as being “confused”. Delirium is reversible but can be very dangerous if it goes untreated, and can result in death.

Delirium may be mistaken for dementia by healthcare professionals, but dementia and delirium are very different conditions. Dementia tends to be more progressive with symptoms that worsen over time. Delirium can fluctuate throughout the day and may be worse at night. Although a person with dementia can have good or bad times within a day, in general, their memory or thinking abilities will remain the same. A person can have both delirium and dementia, and dementia is a risk factor for developing delirium.

It is important to recognize that delirium does frequently affect older adults in hospital and can cause a lot of problems. Delirium may present as cognitive changes, behavior changes and emotional disturbances. Be on the lookout for specific symptoms such as:

1. Lack of focus

2. Poor memory

3. Disorientation

4. Rambling or nonsense speech

5. Moaning

6. Hallucinations

7. Restlessness or agitation

8. Paranoia

9. Anxiety or depression

10. Being quiet or withdrawn

11. Personality changes

Delirium may have one or more causes. The best way to prevent delirium is to be aware of the possible causes which include:

1. Certain medications

2. Malnutrition or dehydration

3. Sleep deprivation

4. Stress

5. Pain

6. Surgery or other medical procedures that include anesthesia

7. Infection

8. Alcohol or drug withdrawal

If you have a loved one in hospital who is confused or exhibits any of the symptoms of delirium, speak to the nurse or doctor immediately. Don’t assume that they have noticed the symptoms and are dealing with them. They may think the person is always confused, or has a previous diagnosis of dementia.

To get to the underlying cause, ask questions like these:

1. How much pain medication is the person receiving? Is their pain well controlled? When did they last receive pain medication?

2. What medications are they on? Could the symptoms be a side effect of any of the medications?

3. How much is the person eating and drinking? Are they getting adequate fluids?

4. How well is the person sleeping? Is the room quiet and comfortable?

5. Is it possible that they have an infection?

6. What has the person’s emotional state been like? Have they been in distress?

Once the cause or causes have been identified, the patient can be treated appropriately. Make sure they drink plenty of fluids, receive antibiotics if an infection is present, that their pain is well managed, and that any stress they may be experiencing is reduced.

Insist that the staff take things seriously, and explain if these characteristics or behaviors are not normal for your loved one. Despite being very common in hospitalized, older adults, delirium is not well diagnosed. The longer it persists, the more dangerous it becomes, and is associated with an increased risk of mortality and morbidity.

Questions? Give Takacs McGinnis Elder Care Law a call at 615.824.2571.