Tips for Managing Delirium in Older Adults

Date:

January 28, 2023

What is Delirium?

Delirium is a term that means “sudden confusion.”  It refers to an abrupt, rapid change in mental function that goes well beyond the typical forgetfulness of aging. Delirium is a result of abnormal functioning of the brain and requires the attention of a healthcare professional.

Types of Delirium

Delirium usually occurs in two forms:

  • A hyperactive form, in which patients are agitated, have increased arousal, or are very vigilant, or
  • A hypoactive form in which patients are lethargic, sleepy, move less than usual, and have little awareness of their surroundings. 

Often, doctors and nurses in a hospital are not aware that an older adult is suffering from delirium because they become less active (hypoactive), rather than more restless (hyperactive). The hypoactive (“quiet”) form is more common, occurring in up to 75% of patients with delirium, and may be mistaken for depression.

Some studies suggest that the prognosis for hypoactive delirium may be worse than the prognosis for hyperactive delirium, possibly because hypoactive delirium is less frequently recognized and less likely to be investigated promptly.

Sometimes, the hyperactive and hypoactive forms switch fairly quickly, so that a delirious person cycles between lethargy and agitation within a single day.

What causes Delirium?

Delirium often occurs when older adults are in the hospital or after they have surgery. Many factors can contribute to delirium, including acute illness, surgery, and medications. In addition, for some people, disruption of their regular routine may contribute to sudden confusion or changes in behavior.

When delirium isn’t recognized, it can delay an older person’s recovery. And prolonged delirium can have a lasting impact on an older person’s health and well-being.

How Common is Delirium?

Delirium occurs frequently especially in older people. Hospital records show that 10-15% of older adults who arrive at emergency departments are delirious. For older adults, the risk of delirium increases with age.

For older adults in the hospital, delirium is one of the most common complications that can happen during a medical illness or following an operation. Approximately one-third of patients over age 70 who are in the hospital experiences delirium, and about 15-25% of older people experience delirium after major elective surgery. Rates can be up to 50% in older adults who have high-risk surgical procedures such as hip fracture repair or cardiac surgery.

Residual symptoms of delirium are present in about half of hospital patients transferred to a nursing home. Over 80% of people suffer from delirium at the end of life.

Signs of Delirium

Family members and friends can play a key role in recognizing and preventing delirium. As a caregiver, friend, or family member, you know the older person better than the hospital staff, so you are often the first person to see signs of delirium. Delirium can start to happen in just a few hours. It can come and go, and symptoms can change quickly. Be sure to report them right away.

  • Confusion
  • Frequent mood swings
  • Memory loss, including forgetting recent events or family members’ names
  • Sudden changes in personality or emotional state
  • Decreased attention or concentration
  • Periods of alertness that come and go throughout the day
  • Hallucinations (seeing or hearing things that are not there)
  • Insomnia and changes in usual sleep patterns
  • Slower movements or unusually restless movements
  • Changes in speech, such as saying things that don’t make sense

Symptoms of Delirium

Delirium is recognized by the presence of a number of specific symptoms, but these may change quickly. For example, someone may move from lethargy to agitation and then back again. The symptoms also vary quite a bit from one person to the next. Delirium may also come and go within a 24-hour period and people with delirium often have lucid (clear) intervals during the course of a day.

  • Sudden onset over hours to days
  • Slurred speech and language difficulties, talking that doesn’t make sense
  • Changes in feeling (sensation) and perception
  • Easily distracted, decreased attention, concentration, and environmental awareness; usually more alert in the morning than at night; in and out of consciousness
  • Changes in movement (for example, may be slow moving or very restless)
  • Changes in sleep patterns, such as reversed sleep-wake cycles
  • Confusion and disorientation, not aware of correct time or place
  • Memory loss, including decreased short-term memory and recall
  • Disorganized thinking
  • Emotional or personality changes, with frequent changes in moods, including anger, agitation, anxiety, apathy, depression, fear, euphoria, irritability, suspicion
  • Incontinence
  • Hallucinations (visual, but not auditory)
  • Signs of medical illness (such as fever, chills, pain, etc.) or medication side effects

Reversible Causes of Delirium

In addition to the above steps, delirium can often be reversed by treating some of the common causes. You can discuss these with the older person’s healthcare professionals. Common causes include:

  • Starting new medications or changing current medication doses
  • Stopping medications that the person has been on for a long time
  • Stopping regular use of alcohol or sleeping pills
  • Pain that is not being treated well
  • Constipation
  • Thyroid problems
  • Infections, especially of the lungs or urinary tract
  • Dehydration
  • Stroke
  • Heart problems, including heart failure and irregular heart rhythms

Is it delirium or dementia?

Many of the characteristics of delirium are the same as those for dementia, but delirium develops far more suddenly and can be reversible when its causes are identified and treated. People with dementia are at high risk of developing delirium, and the two conditions often exist together. Whenever the behavior or thinking of a person with dementia suddenly gets much worse, particularly if the person is sick or in hospital, the cause is likely to be delirium.

Delirium can also be mistaken for psychiatric diseases such as schizophrenia. Hypoactive delirium is often confused with depression. Certain rare forms of epilepsy can also closely resemble delirium. However, in epilepsy there is usually a history of seizures before the episode of sudden confusion.

Dementia vs Delirium

What You Can Do: Caregiving Tips for Older Adults with Delirium

  • Watch for Changes in Behavior or Alertness.
    Since you know the older person best, you can quickly pick up on changes in their mental state. Tell the healthcare staff right away if you notice anything unusual.
  • Stay With the Older Person as Much as Possible.
    Friends and family offer comfort and familiarity. Many hospitals allow family members or friends to stay overnight in the hospital room. Try to provide calm reassurance and comfort. Being there for mealtimes is also important and supports better food and liquid intake.
  • Keep Eyeglasses, Hearing Aids, and Dentures With the Older Person.
    They are often put away at the hospital, and this can leave an older person disoriented and less able to function.
  • Help the Older Person Remember Where He or She Is.
    You can gently and calmly explain why he or she is in the emergency room, hospital, or other facility. Offer frequent, simple explanations of what is happening and of any changes in routine.
  • Make the Person’s Surroundings Feel More Familiar.
    Bring a few family photos and familiar objects to the hospital, such as a favorite blanket.
  • Encourage Physical Activity, Games, and Conversation.
    Ask the hospital staff if you can help the older person sit in a chair or go for a walk. Simple games, quiet conversation, or other pastimes the person enjoys are also helpful.
  • Bring a Current Medication List to the Hospital.
    It’s important for all healthcare providers to know all the medications an older person is taking, along with the dosages. Be sure to include over-the-counter medications and supplements, such as vitamins and herbal remedies. It’s best for an older person to have a medication list with them at all times.
    See: Free Medication Log Templates
  • Bring a List of the Older Person’s Health Problems.
    Having this information written down and on hand is always helpful for an older person, particularly if they are taken to the emergency room. Don’t forget to include any allergies. And also be sure to include contact information for other healthcare professionals involved in the older adult’s care.
    See: How To Build A Medical Binder
Delirium Tip Sheet

Source:

We hope this information is helpful to you in the important work you do as a family caregiver.
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