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Could It Be Delirium - Commonly Mismanaged!

I will never forget the day my mother fell, fractured her hip, and was admitted to the hospital for an emergency 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 all 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 pass over time with the right care and interventions. Things would be unpleasant and difficult for perhaps a little while, but would 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 told them - " I will place a book on a table or a plant on a shelf, but I will not simply place my mother!" When gained composure and got my "Karen" 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. Sadly, they were the ones who did not....

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 was persistent in advocating for my mother and did have some positive interactions and 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.

Just this week I had a patient almost declined entry into assisted living as the clinical staff simply did not understand this. If you need an advocate please reach out as we WILL help you!

So more on Delirium...

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 which can cause behavioral challenges, agitation, marked confusion, and or hallucinations. It is like hitting a light 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 significant agitation, and confusion which can make some healthcare providers think that they in fact may have a type of dementia. It is important to watch for the signs of delirium in older adults when hospitalized and take timely interventions to prevent or minimize.

Delirium will generally pass over time, but the duration of symptoms is different for each person. The best way to manage delirium is to remove or resolve the causative factor - usually creating a safe, stable, calm, and restful environment for the patient is beneficial. Keep the lighting low, limiting noise and visitors generally helps. Have family members provide support to help reinforce safety and to reorient the individual slowly and as tolerated. Go at their pace. And finally, try to limit or avoid pain medications and sedatives. In the hospital patients will often be given drugs such as Haldol for confusion which can make delirium even worse for some sadly. Haloperidol should only be considered for delirium when non-drug methods are not effective, and there are no other conditions present preventing use. Newer neuroleptics such as Olanzapine, risperidone, and quetiapine appear to be adequate alternatives to haloperidol in patients who are susceptible to extrapyramidal symptoms which needs to be considered.(

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 Manager as we are here to help!

I hope that the above helps you or your family!



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