This report is not a substitute for medical advice and treatment. Never diagnose or treat yourself or a family member. See your doctor. Use your voice. Ask questions and share prescription concerns, if any, with your physician.
Delirium is defined as an acute, fluctuating syndrome of altered attention, awareness, and cognition. It is common in older persons in the hospital and long-term care facilities and may indicate a life-threatening condition. Delirium in Older Pateints_AAFP
According to the American Delirium Society approximately 7 million people hospitalized experience delirium each year. This number represents…“10-20 percent of all hospitalized adults, and 30-40 percent of elderly hospitalized patients.” Delirium, Science Daily. Is delirium becoming more common? Are you/your loved ones at risk to be among those diagnosed with delirium at some point in your life?
Growing up with elderly grandparents I never heard the term “delirium”, or sometimes referred to as “sundowners”. Fast-forward 40 years and suddenly these terms are now commonly used when elderly patients are hospitalized. I wonder, “Why? What changed?” Here are 2 individuals, one hospitalized at 95 years old treated for pneumonia with no delirium and the other 82 years old treated for bowel obstruction suffering hospital delirium, for the first of many that followed. How could one elderly patient suffer delirium and the other (elder of the two) not??
It deeply concerns me when attending healthcare professions appear to not have a solid understanding of delirium, quickly treating patients with anti-psychotic drugs for even the slightest agitation or confusion. Equally frustrating is the assumption that patients with this affliction have a psychotic permanent disease, progressive dementia, or Alzheimer’s. It is also discouraging to hear symptom comparisons to others who have been diagnosed with dementia or Alzheimer’s. This leads to mismanaging delirium as well as having a false assumed trajectory, dashing hopes of recovery and making decisions that may not be in the best interest of the patient.
This post shares facts and resources about what delirium is and what it is not, along with proactively managing the risk and onset of delirium if you or your loved one(s) suffer from this affliction. USE YOUR VOICE with hospital staff, sharing your/loved one(s) mental baseline quickly and accurately. Voice your wishes and that of your family to guard against receiving medications that might only exacerbate delirium. Your commitment first and foremost is to your well-being and advocating for the best interest of your family member. Hospital staff will appreciate your advocacy and involvement based on information that will help them best do their job.
What delirium IS and what it IS NOT.
Delirium is distinct from dementia because it develops suddenly, over hours to days, rather than months to years. And unlike dementia, delirium is usually temporary, resolving when the underlying cause is addressed promptly. Delirium also differs from the psychosis of psychiatric disease, in which orientation, concentration and attention are usually less impaired. Delirium (Beyond the Basics), October 2014.
Delirium is a sudden onset of unprecedented psychotic behavior when a patient is hospitalized.The patient becomes either unusually withdrawn or demonstrates uncharacteristic aggressive and paranoid behavior accompanied by hallucinations that are extremely difficult on the patient, the family, and hospital staff. Delirium is a temporary affliction and often when the patient returns to their familiar environment, the delirium disappears as quickly as it came, for most. Delirium can linger with a slower return to baseline if the patient already has been diagnosed with dementia, whose existing illness and physical frailty slows the healing process, or health continues to deteriorate. Delirium is especially likely to afflict hearing and visually impaired patients. A lack of knowledge and understanding about delirium by attending healthcare professionals leads to medications and care practices that can exacerbate a patient’s condition.
Delirium is not a disease. Delirium is not an indication of Alzheimer’s or dementia. One can suffer from delirium and not have either of these diseases. However, the more often and severe one suffers from delirium when hospitalized, the greater the risk of dementia. This, however, does not apply as a greater Alzheimer’s risk. A physician once shared with me the difference between age related memory loss and Alzheimer’s… cognitive memory impairment forgets facts and Alzheimer’s patients forgets function. Both can progress as the patient ages. Delirium is temporary.
Below are two videos I encourage you to watch. One video allows you to experience delirium. The other video shares a delirium occurrence by a man who was hospitalized with pneumonia and the impact on his wife, as well. These videos are great visuals that will inspire you, the readers, to act now and do what you can to reduce delirium risk for yourself and your family members.
Delirium risks…what you need to know.
According to Delirium in Older Pateints, AAFP.org, there are risk factors for delirium and AAFB.org August 2014, Delirium in Older Patients, Table 3 provides a list that will surprise you! Some of the most common risks fall under these categories:
- Predisposing Factors – Comorbidities (alcoholism, chronic pain, history of baseline lung, liver, kidney, heart, or brain disease, terminal illness), Demographic (65+ years old), Geriatric Syndromes, Premorbid State
- Precipitating Factors – Acute Insults and Environmental Exposures
- Delirium-inducing medications
How to prevent and manage delirium and what to avoid.
About 40% of delirium cases are preventable. In the past decade, progress has been made in increasing awareness of the potential negative outcomes of delirium and documenting reliable methods to detect and prevent it. Prevention of delirium now focuses on eliminating or reversing as many risk factors as possible. Delirium in the Elderly
When researching delirium be sure the articles are current. Each year new information is surfacing based on patient studies, early detection, and treatment without the use of drugs.
Before a planned surgery, discuss delirium risks and best management practices with your/family member’s surgeon. Be in agreement and on the “same page” of what medications you are OK taking and which you do not want. If admitted to the ER, be sensitive to any signs of slight confusion, which could be a sign of delirium that could become worse with prolonged hospital stays. Discuss, with the attending physician, proactive non-invasive measures to best manage delirium from the start. I recently heard about hospital staff treating a delirium patient that of which is listed under what to avoid below. Be bold in sharing concerns if this might be your experience, as well. The elderly population of baby boomers is rapidly increasing in numbers and, therefore, every hospital should have up-to-date delirium training for all staff to understand and properly treat this affliction.
Delirium management suggestions.
- Stay calm.
- Surround the patient with family photos as soon as possible.
- Bring patient’s favorite pillow and/or blanket.
- Play the patient’s favorite music in their hospital room.
- Turn on the TV to favorite TV shows.
- Keep window drapes open at all times so the patient can discern daytime and nighttime to maintain normal sleep cycles.
- Carefully schedule visitors, family, and very close friends for familiarity and avoid over stimulation which could further irritate delirium.
- Melatonin (suggested by a physician), is a natural way to calm a delirium patient and encourage normal sleep-wake cycles.
What to avoid.
- Physical restraints
- Foley catheters
- Intravenous lines
- Psychoactive and sedative agents
- Drugs with anticholinergic effects (Anticholinergics, June, 1, 2018)
- Daytime napping
- Continuous questioning by hospital staff
- Anti-psychotic drugs, whenever possible
- Prescription sleeping aids
- Family members correcting patient’s paranoia and hallucinations
The Hospital Elder Life Program offers a wealth of information and support for family members and medical staff. CLICK HERE for the brochure.
Below are a few quotes from…Delirium in Older Pateints, AAFP
Studies have demonstrated that a multicomponent non-pharmacologic approach is highly effective and reduces the number and duration of episodes of delirium. One such intervention, known as the Hospital Elder Life Program, is available at [CLICK HERE].
Non-pharmacologic prevention strategies consist of orientation and therapeutic activities, early and recurrent mobilization, minimizing the use of psychoactive medications, promoting normal sleep-wake cycles, providing easy access to adaptive equipment for sensory impairment (e.g., glasses, hearing aids), and preventing dehydration. Orientation activities should include encouraging familiar visitors, minimizing changes in nursing staff, and ensuring that functional clocks and calendars are easily visualized. All caretakers should be educated on preventive approaches and encouraged to implement them. The Hospital Elder Life Program has also developed the Family Confusion Assessment Method, a validated screening tool that can be used by trained family members to detect delirium. This tool has a demonstrated sensitivity of 86% and a specificity of 98% in one study of 58 caregivers.
The future diagnosis of delirium.
Anti-psychotic drugs are often quickly administered to hospital patients today who show signs of confusion/agitation. According to US National Library of Medicine, Feb, 2013…No antipsychotic drugs have been approved by the U.S. Food and Drug Administration (FDA) for the management of delirium, despite the reality that antipsychotics are routinely used in the management of symptoms related to delirium.
Another resource, Critical Care Nurse – AACN Journals, indicates a similar message shared twice, as noted below, from article Assessment and Management of Delirium Across the Life Span, 2016 and Delirium Assessment and Management, 2012
No drug has been approved by the FDA to treat delirium. In fact, the FDA has issued an alert that atypical antipsychotic medications are associated with mortality risk among older patients, and another analysis has reported that haloperidol had an even higher mortality risk in non-ICU older patients than atypical antipsychotics.
There is hope. Blood Test May Help Predict Confusion After Surgery, January 2017, indicates a blood test has been identified that could predict the onset of delirium. (Quote below.) Early and accurate detection could encourage proactive and proper ways to work best with at-risk-patients, avoiding the use of pharmaceutical drugs whenever possible.
This study is a step toward preventing postoperative delirium,” said John Krystal, Editor of Biological Psychiatry. “With information about delirium risk, doctors can take steps before, during, and after surgery to reduce that risk,” for example, by reducing inflammation in patients with higher levels of CRP.
What can you do now to minimize your risk?
Share concerns about delirium risk with your doctor, if you are suddenly hospitalized or perhaps someday face the need for surgery. Review all prescription medications with your doctor to identify those that could increase delirium risk and alternative options to consider. AAFB.org August 2014, Delirium in Older Patients, Table 3 is a great chart for discussion with your physician. If a prescription drug lists confusion, hallucination, and cognitive memory impairment as possible side effects, I would want to consider an available alternative and you may as well.
Stay healthy. Exercise and eat a well balanced diet. If you feel you are falling short in this area, begin today! Good health will minimize your need for prescription medications, which will reduce delirium risk. Get the help you need. Wellness Changer, Jeanne Wisniewski offers information packed videos and custom nutritional consultations to help you. View videos HERE and HERE.
Watch alcohol intake. Drinking heavily (more than 1 glass per day for women and 2 glasses per day for men), can also increase delirium risk. Over 65 years of age…one drink per day maximum for men and women. See Alcohol Consumption Limits by Moderation Management
If you watched the videos listed above, you will never want to experience delirium and/or see your loved ones suffer from this affliction. Earlier in the article I refer to two individuals; a 95-year-old with no delirium and an 82-year-old who suffered with hospital delirium. What is the difference between the two patients? The 95-year-old was fortunate to enjoy great health and therefore never had to be on prescription drugs other than a light dose of blood pressure pills. Through life, this individual had one surgery and two hospital stays to treat infections. The 82-year-old patient suffered from autoimmune disease, was on many prescription medications, and went through 12 surgeries in life. Advances in research and pharmaceutical development have saved lives, but, are we the generation experiencing unwanted side-effects from all the prescription drugs available today? Is delirium one of those side-effects?? Be informed. Use your voice. Ask questions. And, speak candidly with hospital staff about your treatment options and/or advocating for the care of your loved one(s). Delirium can be preventable if this temporary affliction is understood and managed for what it is. Be proactive now because delirium…can happen to you!
The Communication Failure In Medical Record Keeping, September 28, 2018 by
When a patient with a complex medical history like Michael’s arrives under my care, it’s like opening a book to page 200 and being asked to write page 201. That can be challenging enough. But on top of that, maybe the middle is mysteriously ripped out, pages 75 to 95 are shuffled, and several chapters don’t even seem to be part of the same story.
- Delirium in Older Pateints_AAFP, August 2014, VIRGINIA B. KALISH, MD, National Capitol Consortium, Fort Belvoir, Virginia JOSEPH E. GILLHAM, MD, Robinson Health Clinic, Fort Bragg, North Carolina BRIAN K. UNWIN, MD, Carilion Clinic, Roanoke, Virginia
- American Delirium Society
- Delirium, Science Daily
- Delirium (Beyond the Basics), Review Current through September 2018, Updated October 2014, Authors: Joseph Francis, Jr, MD, MPHG Bryan Young, MD, FRCPC
- Trailer Delirium Experience, Dec 22, 2014, IJsfontein, YouTube Video
- Delirium: A Patient Story at Leicester’s Hospitals, England, June 20, 2017, YouTube Video
- Delirium in the Elderly By Sue Fosnight, BSPharm, BCPS, CGP Reviewed by Christine M. Ruby, Pharm.D., BCPS; and Jeffrey T. Sherer, Pharm.D., MPH, BCPS
- Anticholinergics, June, 1, 2018, Medically reviewed by Lindsay Slowiczek, Pharm Don June 1, 2018— Written by Jacquelyn Cafasso
- Hospital Elder Life Program
- Family Confusion Assessment Method
- US National Library of Medicine, Feb, 2013
- Assessment and Management of Delirium Across the Life Span, October, 2016
- Delirium Assessment and Management, February 2012
- Blood Test May Help Predict Confusion After Surgery, January 11, 2017, Elsevier
- Wellness Changer, Jeanne Wisniewski, YouTube Videos and Previous Facebook Video Inventory
- See Alcohol Consumption Limits by Moderation Management
- Predicting long-term cognitive decline following delirium, March 15, 2017, Science Daily Hebrew SeniorLife Institute for Aging Research
- When Patients Suddenly Become Confused, Updated May 2018, Published May 201, Harvard Health Publishing
- he Communication Failure In Medical Record Keeping, September 28, 2018 by
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