Dementia versus Delirium
I will never forget when my mother fell, fractured her hip and was admitted to the hospital for an emergency total hip replacement. The entire situation was so traumatic and frightening for her and for our family! After she came out of surgery, thankfully without complications, she was very disoriented. At first we assumed that it was due to the anesthesia, but realized later that it was in fact delirium. Being a nurse, I knew immediately how to handle this situation and that it would in fact pass over time. Things would be unpleasant and difficult for awhile, but slowly improve!
The nursing staff caring for my mom sadly had a different opinion. I was so disappointed and irritated that some of her primary caregivers were unable to distinguish between delirium and dementia, as they kept asking me how long my mother had dementia. How did we manage her at home? Had we stared talking about placement? Placement? Placement for what, temporary confusion? They acted as if my mother was an object and not a person. I will place a book on a table or a plant on a shelf, but not my mother, I told them. When I finally got my emotions under control, I explained that she did not have cognitive issues. They looked at me sadly implying that I was another one of those unrealistic family members. In their eyes, I just did not get it.
It saddens me that people are so fast to assume that every person with confusion over the age of 65 is demented. This is pure and simple ageism due to ignorance and needs to stop. There are so many other factors to consider when someone has a change in cognition. Never assume! Could they have a urinary tract infection, blood sugar problem, could they be septic, could they be having TIA's or small strokes? Why jump immediately to the dementia conclusion? I will never understand this. Fortunately, not everyone is this way! I did have some positive interactions and came across some excellent health care providers who understood and supported my mom throughout this process. Below I will clarify further the differences between Delirium and Dementia, to hopefully prevent some of these issues and potential anxiety for others.
Dementia is something that happens generally over time, with a continuing progressive cognitive decline. On the other hand, Delirium is something that has an immediate or rapid onset of cognitive changes. It is light hitting alight switch. Usually it is sparked by a traumatic or stressful event or circumstance, such as a hospitalization. The symptoms can come and go and are individual for each person. The most prominent symptom seen is confusion or a of lack the ability to focus. Simple processing of thoughts, and completion of tasks become impossible. People also can have agitation, and confusion which can make some healthcare providers think that they in fact may have a dementia.
Delirium will generally pass over time, but the duration of symptoms is different for each person. The best way to manage delirium is to create a safe and restful environment for the patient. Keep the lighting low and limit noise and visitors. Have family members provide support to help reinforce safety and to reorient the individual. And finally, try to limit or avoid pain medications and sedatives.
It is important to become familiar with the signs and symptoms of delirium as it is common in older adults. Remember if you have questions regarding a cognitive change in a family member you can receive guidance from an RN Care Manger as we are here to help!