Delirium: The Often-Missed Hospital Complication

When your loved one with dementia is in the hospital, you're probably focused on the procedure or crisis at hand. But you're also likely to encounter a serious medical issue that you may have never heard of -- and that's often not on the top of doctors' and nurses' minds, either: delirium.

Delirium is a state of worse-than-usual brain function. In those with dementia, it usually means more confusion than usual, although it's also possible for delirium to make someone quieter and more "spaced out." (In patients without dementia, delirium causes new confusion.)

Delirium affects as many as one in three older adults admitted to hospitals, with those numbers skewing higher among those who have preexisting dementia, undergo surgery, or are hospitalized in the intensive care unit. Research studies have shown that patients with delirium tend to have longer hospital stays, more hospital complications such as falls, and are less likely to do well after hospitalization. It can also take days or weeks for a person to recover from a substantial bout of delirium. Some dementia patients never recover to their previous mental abilities.

Despite its prevalence, delirium often gets missed in busy hospital settings. This can lead to delays in identifying a new serious illness (such as a urinary infection or even a heart attack). Delirious people with dementia often also have trouble moving about safely or participating in physical therapy.

Fortunately, caregivers can play a critical role in preventing and identifying hospital delirium. Here's what to know and what to do:

Know why the hospital staff might miss delirium

Delirium is often missed during hospital stays due to several factors:

• Hospital staff don't always know what a demented patient is like "normally" (that is, what's normal for that individual).

• Delirium and dementia are often confused in a hospital setting. So the staff sees the delirium symptoms but assumes they're "just dementia" instead.

• Hospital staff often misunderstand what delirium symptoms look like. In particular, some doctors and nurses may not realize that delirium can cause a person to be much quieter than usual.

• Hospitals are hectic places and patients aren't seen by the same person at regular intervals, so it's more difficult for staff to notice the changes in mental state that are caused by delirium.

• Prevention techniques aren't standard.

That amps up the role of family members, who know the patient best and who are, optimally, right there at the patient's side throughout hospitalization.