Delirium in the Elderly
Medical literature has included descriptions of delirium for more than 2,000 years. It is a common condition characterized by the sudden onset of attention problems, disorientation, agitation, memory loss and language difficulties.
Patients who are delirious may have slurred speech, be easily distracted, go in and out of consciousness, feel anxious or fearful, or experience hallucinations.
They also may have a hard time following directions, appear restless, withdraw from their surroundings, experience sleep problems, or have an unsteady gait and tremors. Fortunately, delirium tends to be a temporary condition.
However, it often appears in the elderly who are hospitalized, especially those 75 or older and patients with severe underlying health conditions or cognitive impairments.
Recognizing delirium requires careful observation and awareness of changes in mental state and behavior. While not all causes of delirium are known, some reversible sources that have been identified include:
- Increased drug dosages or drug interactions
- Electrolyte disturbances resulting from dehydration or thyroid problems
- Stopping the use of long-term sedatives
- Urinary or respiratory tract infections
- Poor vision or hearing
- Brain infection, hemorrhage or stroke
- Inability to urinate or have a bowel movement
- Heart or lung problems
Medical conditions associated with delirium include dementia, burns, malnourishment, chronic hepatitis disease, dialysis, Parkinson’s disease, HIV infection, and after cardiac, hip or transplant surgery.
If an underlying medical condition cannot be identified as the cause of the delirium, a medical history and physical examination may be necessary.
Diagnostic tests could be recommended as well, including blood or thyroid function tests, urinalysis, electroencephalogram (EEG), cerebrospinal fluid analysis, and magnetic resonance imaging or computed tomography scan of the head.
Delirium treatment depends on correcting the underlying medical disorder causing the condition. The most common and treatable cause of delirium is side effects from certain medications, such as narcotics, sedatives, corticosteroids and atropine.
Once the cause of the delirium has been identified, treatment can address managing symptoms and providing supportive care.
Care for a patient with delirium should take place in a calm, comfortable and safe environment. Patients should be reminded on a regular basis about where they are, why they are there, and the current month, week and day.
Frequent visits by family members or friends also may be beneficial, as well as placing photos of loved ones within the patient’s line of sight.
Window views also can help orient the patient and dim lights can be left on at night to help reduce hallucinations or delusions. Having eyeglasses or hearing aids can keep patients in touch with their surroundings.
Delirium patients – especially older adults – tend to have poorer outcomes, longer hospital stays, and more medical complications, such as pneumonia and pressure ulcers. If left untreated, delirium can lead to a coma or death.
However, most patients recover fully after experiencing delirium for approximately one week, although mental function may not return to normal for several more weeks. For more information about delirium, talk with your doctor or visit the Health in Aging website at www.healthinaging.org.