Hospital Delirium a Risk for Elderly

Delirium affects about 1 out of 3 hospital patients over age 70. It's even higher for those who are in intensive care or recovering from surgery. And hospitals increasingly are trying to treat or prevent it, the New York Times reported June 20. People with delirum often have hallucinations. They may become violent or act in ways that cause them to get hurt. Nobody is sure of the causes, the Times reported. Infections, surgery or insertion of a catheter may make frail patients anxious. Some medicines also may be triggers. Changes in routine and location can be a factor, the Times said. People have their sleep interrupted for tests. They may not have their eyeglasses or dentures. Delirium can slow down recovery. About 35% to 40% of older adults with hospital dementia die within a year, a study found. Those who survive may have an increased risk of dementia. Some hospitals are stopping unneeded medicines, removing catheters and assessing mental function more often. The aim is to help prevent anxiety, disruption and delirium.

What Is the Doctor's Reaction?

When I was a doctor in training, nurses called us often to tell us that a patient was "confused." I remember one woman in particular. She was about 90 years old. At night, she would begin to cry, calling for help because there were bugs outside her window. I can't remember what happened to her, but I do remember thinking about how scared she must have been.

This woman wasn't just confused. She was delirious. She didn't know where she was, who she was, or even what time it was. We did our very best to care for these people. But I don't think we really understood that their delirium threatened their lives.

Delirium is increasingly recognized as dangerous for patients. Delirium is triggered by:

• The experience of being ill


• Drugs we use to treat the illness (and sometimes to treat the delirium itself)


• The disruption and anxiety of being in the hospital

Once delirious, people:

• Take longer to get better in the hospital


• Are more likely to be placed in nursing homes and rehab centers


• Have a greater risk of dying in the next year

People with dementia are at greater risk for delirium. People who get delirious, in turn, are at greater risk of developing dementia later. It isn't clear that delirium causes dementia. It may be just a "marker," something that identifies a person who might develop dementia.

Several hospitals have developed delirium prevention programs to help patients remain oriented and feel safe. For example, one program carefully adjusts patients' schedules, allows them to sleep and makes sure that they have their glasses and hearing aids. Another hospital makes every effort to remove people's intravenous (IV) lines. Staff members also assess patients' mental state often. This allows delirium to be diagnosed and treated before the patient is even more at risk.

The increased recognition of delirium and attempts to prevent and treat it are incredibly important for the health of our aging population.

What Changes Can I Make Now?

Learn to recognize the signs or symptoms of delirium if a loved one is in the hospital. Delirium is a state of acute confusion. It's most common in elderly people. However, other adults and children can also become delirious when they are ill or in the hospital.

You might see:

1. A change in someone’s alertness. He or she is OK in the morning and confused at night.


2. Change in sleep patterns


3. Inability to remember things


4. Disorganized thinking and speech


5. Personality changes, include an increase in anger, fear and anxiety


6. Clear confusion or hallucinations

Health care professionals may not know your loved one. It is important to help them understand that this is not typical behavior. Delirium often is caused by medicine or illness. Make sure that hospital staff evaluate your family member for infections and abnormal lab tests. They also should carefully review medicines and stop any that are not absolutely necessary.

You can help family members by your presence. Make sure they have glasses or hearing aids. Talk to them, read to them, and make their room or environment as familiar as possible.

What Can I Expect Looking to the Future?

Delirium isn't a high-tech kind of illness. We are unlikely to see lab experiments about this condition. We are unlikely to develop drugs to treat it.

Yet our population is aging. Older people, more than others, are at high risk for delirium. I think that we can hope to see better awareness of delirium and better prevention and treatment programs. I also hope for increased awareness about the best medicines to treat people safely while helping them to stay mentally sharp.