Tips to help prevent delirium in the hospital
Have you ever heard of delirium? This disorder isn’t generally understood, but it is a common concern among older adults in the hospital.
It’s an acute disorder, which means it usually appears suddenly and doesn’t typically last too long. It can develop in as little as a few hours and symptoms tend to fluctuate in severity throughout the day.
People with delirium have problems with attention and awareness, but the symptoms are not always easy to identify.
A patient with delirium may have difficulty following a conversation and may get confused about their environment to the point that they don’t recognize they are in the hospital. Changes to the patient’s physical environment — like moving them to a new room — may make symptoms worse.
People with delirium can act confused and may be forgetful, restless, easily startled, have slurred and rambling speech, be unaware of their surroundings, sleepy, imagine things and confuse night and day, among other symptoms. What’s the difference between dementia and delirium?
Dementia develops over months, with a slow progression of cognitive decline over years. Delirium occurs abruptly over a few days or weeks, and symptoms can come and go during the day. A person with dementia is much more likely to develop delirium when hospitalized.
The main difference separating delirium from dementia is inattention and level of alertness. The individual with delirium simply cannot focus on one idea or task. This inattention is usually present in later stages of dementia.
Level of consciousness for patients with delirium may fluctuate from very tired to very easily startled whereas patients with dementia are normally alert unless they are in the later stage of the disease.
There are several risk factors that can make a person more likely to develop delirium.
The tips below will help you to reduce these risk factors in the hospital: 1. Cognitive impairment: People with existing dementia or mild cognitive impairment are more likely to develop delirium. Look out for signs of changes in thinking like memory loss or difficulty with daily tasks.
How to help: If someone has cognitive impairment, keep their mind active while they’re in the hospital. Ask questions about current season, holidays, past hobbies and family members. Bring familiar items, such as board games or books to their room to help occupy them.
2. Sensory impairment: Hearing or vision loss can make it more difficult for someone to assess their surroundings and can contribute to delirium.
How to help: Bring their sensory aids with you to the hospital and label them. If they typically wear hearing aids or glasses, make sure they wear them during their hospital stay.
3. Loss of mobility: Lack of movement can make someone more likely to develop delirium. A patient who walked independently before hospitalization may feel unsteady during their illness or after an operation, and need assistance with a walker or other mobility device.
How to help: Advocate for removal of tethers such as IVs and oxygen tubes, and urinary catheters. Encourage the patient to move throughout the day to keep their muscles strong.
4. Dehydration: When people get dehydrated, they are significantly more likely to develop delirium. How to help: Watch out for physical indicators of dehydration like muscle weakness, speech difficulty, dry mouth and a pale lining inside of the mouth. Encourage drinking throughout the day as long as taking liquids is OK’d by the care team.
5. Recently added medications: New medications can increase someone’s risk of delirium. The medications most often associated with delirium are benzodiazepines and anticholinergics.
How to help: Discuss alternative medications with the care team to reduce risk.
If delirium develops while your loved one is in hospital tell the staff right so a plan of care can be developed with staff to help with the confusion.
Hamilton Health Sciences has a Hospital Elder Life Program (HELP) service available for patients over 75 who are in select clinical areas at Hamilton General or Juravinski hospitals. If your loved one develops delirium, ask if these services are available on their unit.