Karen McPhail, RN, MSN
Could It Be Delirium???
Delirium is a huge problem for seniors as it is often times misdiagnosed and mis managed as a result. Delirium is not dementia! Often times I hear health care providers say to loved one: "They have dementia right?" or " That family is in denial." As a care manager I am often the one who needs to intervene, advocate, and set the record straight with health care providers to ensure proper care for my clients. It saddens me that people are so quick to jump to the dementia diagnosis before assessing and getting to know the patient. I hope that this can change with further education int he medical community!
In terms of distinguishing between delirium and dementia...
The onset of delirium is much different as it is a rapid onset of hallucinations and confusion versus dementia which manifests generally over time.
Delirium comes on fast, symptoms can change and fluctuate throughout the day, and symptoms can also resolve quickly under the right conditions and if specific aspects of care are considered.
So what can lead to an episode of delirium?
Extreme or prolonged stress
Being hard of hearing or having a vision impairment
Dehydration, blood pressure changes, medications
Or the withdrawing narcotics or from alcohol
Anytime a person is admitted to the hospital over the age of 65 they are at risk for delirium. Hospitals are frightening, stressful, loud, hectic, and busy places! Patients are at the mercy of the caring for them and there is not set schedule or pattern for things. Someone pops in to draw blood without warning or a stretch appears with a persons saying you re going down to CT. A hospital environment is truly not a conducive environment for most seniors. The stress, lack of routine, and constant disruption of sleep patterns all leads to delirium. This is especially worse for those in the ICU who often times experience delirium more often due to the alarms and other constant noises and direct care needs.
The NIH noted in a research study article by Tamara G. Fong, Samir R. Tulebaev, and Sharon K. Inouye:
"In elderly individuals, delirium can initiate or otherwise be a key component in a cascade of events that lead to a downward spiral of functional decline, loss of independence, institutionalization, and, ultimately, death.
Delirium affects an estimated 14–56% of all hospitalized elderly patients.
At least 20% of the 12.5 million patients over 65 years of age hospitalized each year in the US experience complications during hospitalization because of delirium."
They also noted the following key points:
Delirium is a frequent cause and a serious complication of hospitalization and has important implications from both a functional and an economic standpoint
Delirium is potentially preventable and treatable, but major barriers, including underrecognition of the syndrome and poor understanding of the underlying pathophysiology, have hampered the development of successful therapies
Neuroimaging has identified structural changes, including cortical atrophy, ventricular dilatation and white matter lesions, to be predictors of delirium
Delirium is not always transient and reversible, and it can result in long-term cognitive changes
Spreading awareness, educating health care providers and seniors is critical to prevent misdiagnosis, mismanagement, and complications!
If you have a loved one who is hospitalized and becomes suddenly confused or begins to have hallucinations, stress to those providing care that this IS new and that it could be delirium. Ensure that you advocate for your loved one to ensure that they get proper assessment and management.
Key considerations to assist in a successful outcome and to help clear delirium:
Control the environment!
A spa like environment is best!
Keep things low stress and low activity
Ensure proper rest and sleep!
Ensure that hearing aids and glasses are used properly! Glasses should be clean and hearing aids operational!
Provide support through light music, aromatherapy, therapeutic touch such as hand holding, a back rub, a hug, etc
Low relaxed lighting
Discourage any sleeping pills use as this can make things worse!!!
Encourage physical activity on their terms to avoid over stimulation.
Encourage low stress activities and those that provide comfort or that they have enjoyed in the past
Ensure proper hydration and balanced nutrition
Slowly increase stimulation and activity over time and as tolerated.
Recent article: March 20, 2018 CBC News: