I recently learned about hospital delirium when my 92-year-old friend suffered it. Her condition was particularly alarming because it came on so quickly.

A fall that fractured her shoulder and wrist landed her in the hospital. After several hours in the emergency room, she was admitted — exhausted and confused.

Her well-being concerned me, but I was equally worried about the emotional state of her caregiver husband. In the time between the fall and her first full day in the hospital, he had imagined a worst-case scenario. His normally bright, engaging wife was presenting as uncooperative and disoriented. She didn’t know where she was or what was happening.

He worried she wouldn’t recover and that her sudden mental decline would worsen. He envisioned a future where she remained confused and helpless. Was he equipped to care for her around the clock?

Four days later my friend left the hospital, entered a short-term rehab facility, and after a few days regained some of her awareness. Her wicked sense of humor re-emerged from time to time, and she was beginning to show improved mobility during her physical therapy.

It was as if the fog was lifting.

This is the nature of a common complication known as hospital delirium, which can affect many senior patients, even those with no prior dementia diagnosis. It affects up to half of older adults during hospitalization, according to Leslie Kernisan, MD, MPH, and geriatric specialist.

Listen to Dr. Kernisan’s interview with Sharon Inouye, MD, and nationally-known expert on delirium. 

Hospital delirium is serious, and although it’s common, it’s not normal. It’s easily misdiagnosed or not recognized by staff unfamiliar with a patient’s medical history.

Caregivers who learn about this troubling condition are better prepared to observe their hospitalized loved ones and speak up if they notice a change in their person’s behavior. 

Why does delirium show up in the hospital?

There are many medical problems that can contribute to delirium. Factors that lead to your loved one’s hospitalization often result in delirium.

It’s a long list. And it’s easy to see that one person may have a number of conditions that complicate their mental state. Conditions such as:

• serious illness
• side-effects of medication
•  infection
•  injury
• dehydration
• metabolic imbalances, such as low sodium
• sleep deprivation
• excessive pain
• untreated hearing or vision impairment
• constipation
• untreated dental conditions

Is it delirium or dementia?

Delirium is temporary and mainly affects one’s attention. It may be described as disorganized thinking and can look like dementia because the person acts confused.

Dementia, however, impairs memory. It’s a chronic condition that gradually worsens.

Those with cognitive impairment are more apt to develop delirium. Brains with dementia are vulnerable to overload, and delirium’s onset may occur more quickly for them.

For patients who are already diagnosed with Alzheimer’s or dementia, it’s possible for medical providers to overlook delirium. For this reason, caregivers will do well to observe, report, and ask for their loved ones to receive a clinical delirium evaluation.

Read more about the Confusion Assessment Method (CAM) used by medical professionals.

You may also be interested in the Family-CAM, designed for medical providers to interview family caregivers.

Why hospital delirium is serious

Many hospitalizations, like my friend’s, start with a trip to the emergency room. It’s easy to see how an ER can feel chaotic and readily contribute to a patient’s confusion. Busy emergency staff may not recognize signs of delirium in the early stage of hospitalization.

“Delirium is an emergency. It is a serious medical problem,” says Dr. Kannayiram Alagiakrishnan, Associate Professor of Geriatric Medicine at the University of Alberta in Edmonton.

There are a number of factors that make delirium a dangerous condition.

It can be a sign of undetected illness. Delirium may be a response to possible life-threatening conditions, such as heart attacks, infections, or pneumonia. In some cases, it may be the only noticeable symptom of something more serious.

Delirium increases the risk of falls. A patient who is disoriented and confused is at a high risk of falling. Their judgment may be impaired, they’re unable to navigate unfamiliar surroundings, and they may have dizziness from illness or medication.

Hospital staff may not recognize a patient’s condition as delirium. Health care providers are often not familiar with a patient’s usual state of mind. They might not realize your loved one’s confusion is worse than usual. If your person does have an Alzheimer’s or dementia diagnosis, delirium might be missed altogether.

Delirium can lead to more serious problems. Untreated delirium may lengthen a hospital stay, which in turn can increase the possibility of additional complications, such as pneumonia or blood clots.

Spotting the signs of hospital delirium

No one knows your loved one as well as you. As their caregiver, you can provide important insight to hospital staff. If you notice changes in your loved one’s behavior and mental state, be sure to alert medical providers to your observations. This can help them to address the problems that may have caused or worsened the delirium.

Delirium looks different from patient to patient. Incoherence and poor orientation are common, but some patients present as restless and aggressive. Others may seem dazed and listless, making diagnosis especially difficult.

Symptoms may come and go. “Fluctuation is a hallmark of delirium,” says Dr. Angela Catic, geriatrician and instructor at Harvard Medical School. 

Ways to minimize delirium — how caregivers can help

There are several ways caregivers can help to prevent hospital delirium in their loved one. While it’s not possible in all cases to completely avoid the condition, there are still steps you can take to minimize the severity of it.

Be there for your loved one. Spend as much time as you can at their bedside. Ask for help from other family members and friends, and have someone there around the clock if possible. Be familiar with existing medical conditions and medications. Always be vigilant about your loved one’s care, ask questions, and advocate for their comfort.

Maintain a calm presence. You can help your loved one avoid emotional distress by reassuring them of your presence. Keep things positive, even, and simple. Loud noises and conversations can be overstimulating and cause additional strain.

If your loved one needs glasses or hearing aids, make sure these are available. If your patient struggles to see or hear, this can increase disorientation.

Try to limit sleep disturbances. Sleep deprivation can intensify delirium, so do what you can to keep the hospital room quiet. Find out if it’s possible for the night nurse to skip middle-of-the-night vital sign checks. Be aware that sleep medications can worsen the effects of delirium.

Keep your loved one active. Ask the physical therapist about activities that can be safely done, and urge your loved one to keep moving.

Keep your loved one oriented to time and place. Open window coverings during the day so they can see outside. If they need a wheelchair, take them around the facility so they can get an idea of where they are, and provide a narrative with the tour. Spending some time in a community room or another part of the hospital ward provides a change of pace. A clock and calendar in the room help them know the date and time.

Furnish objects from home for familiarity. Family photos are reassuring. Bring a favorite blanket or pillow for comfort. Encourage other family members and close friends to visit and bring news of home. Even if there’s little conversation, the simple presence of someone they love can help reorient them.

Ask about any discomfort they’re having. Your patient may hesitate to mention pain to their medical provider, so if they share this information with you, you can alert the hospital staff. Untreated pain can worsen delirium. You are your loved one’s best advocate.

When does delirium get better?

Your loved one’s delirium may linger to some degree for a long time. While bringing them home and reorienting them to a familiar environment often spells improvement, there may be traces of the condition for weeks, months, or longer.

The American Geriatrics Society CoCare HELP program recommends talking to your loved one about their experience with delirium. They may remember no more than feeling confused and frustrated, but offering an opportunity to talk about it can ease their anxiety. Understanding more about the episode enables them to put a label on what happened and aids in your loved one’s healing.

Your presence as a caregiver, along with visits and assistance from family and close friends, are particularly important. Your loved one needs to feel secure amid comfortable surroundings.

SeaCare can help you plan a routine for your family member that balances their need for familiarity and stimulation. During periods of recovery and readjustment from hospital stays, we can provide the additional support you may need. Contact us to learn more.

Katie Wright writes about aging and senior wellness from Bellingham, WA. You can read more about her here.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666867/

https://betterhealthwhileaging.net/what-is-delirium-10-things-to-know/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255198/

https://help.agscocare.org/