What Is Delirium, and What Causes It?
Delirium is a state of acute mental confusion, meaning a person's state of mind suddenly becomes worse than usual. Delirium can cause a person with a perfectly healthy mind to behave like a person who has dementia. For persons with dementia, delirium makes their mental state worse. The key is that it's a sudden change from what's normal for that individual.
The main signs of delirium usually include:
Confused thinking.
Difficulty focusing.
Difficulty paying attention.
The person with delirium may also:
Appear agitated (or "revved up"), or the opposite: drowsier or quieter than usual.
Hallucinate or have delusions (false beliefs not in sync with the person's usual cultural beliefs).
It's common for the mental confusion to fluctuate throughout the day, with the delirious person sometimes seeming like his or her usual self and then, say an hour later, appearing much altered.
Delirium is usually a sign of a stress, such as an illness, affecting the body overall. Common serious causes include infections (such as urinary tract infections or pneumonia), abnormalities of blood chemistry (such as high levels of blood sugar or sodium), dehydration, or even excessive pain after surgery. Delirium can also be caused by or worsened by intoxication or by certain medications (such as antihistamines, which have side effects that influence brain chemistry).
Although younger people with healthy minds can develop delirium, elderly people and people with dementia are especially prone to becoming delirious when sick. A frail elder may also develop delirium when stressed by seemingly minor issues such as constipation, lack of sleep, or not having eyeglasses and hearing aids while in the hospital.
Research has shown that delirium is common in hospitalized patients; up to 50 percent of postsurgical patients may be affected. Unfortunately, delirium is often missed by hospital personnel.
Especially in a frail older person, delirium can be the only outward sign of a serious medical illness. For this reason, any new or suddenly worsened mental confusion needs to be promptly brought to the attention of a medical provider. Since a delirious person may not be able to answer questions properly, it's especially important for a caregiver to help describe the problem. Be sure the doctors realize that the mental confusion is new, or worse than usual.
Thank God, Caring.com warned me about delerium in my 83 year old mother and I was able to recognize it and understand what was happening. Every time she gets a UTI, she is like a time bomb about to go off. As soon as I suspect one, I get her to the doctor and amazingly they question my request for a urinalysis. Which comes back positive!
But after a few days on antibiotics, she returns to her normal state of dementia - to our relief. No it isn't easy and it isn't always pretty, but knowing what is happening with her helps us cope.
When she admits that she cannot remember things, it helps when we sympathize with her and assure her it's O.K. that's why we are here - to help you remember. Unless she is experiencing delerium, it usually works!
Thank you for making my life easier.
It is destressing when Dr.'s say they can't listen to family they have to listen to the patient because she still is her own guardian. My mother has suffered from delirium that has been severe. You read how some get help and diagnosised early while others are out here fighing with Dr.'s who have no business being Dr.'s. This defination here is mild and very kind in its description to what we have experienced.
This question would best be posed to one of the Dr.'s because I am not a Dr. but from what I have read on the subject it could be caused from the protein that forms plaque in the brain and does nerve damage thus causing seizures.
How timely this topic is. My mother was admitted to the hospital earlier this wk with what turned out to be bronchitis. On the phone with her this morning she seemed agitated and even a little delusional. It's impossible to reason with someone in this state and I was so taken aback because she's never been like this but she's had a bit of change lately. Two days after she moved into Assisted Living she fell, fractured her pelvis and was in rehab for 2 mos. After being discharged and only back in Assisted Living apt for 4 days, she wound up in the hospital with what's been diagnosed as bronchitis. I spoke to the nurse who confirmed her confusion this morning. I later spoke with my mother, never mentioned our earlier phone call and she's better. That was scary and sad at the same time, particularly when you just feel helpless.
I have found it is very important to work with a doctor who specializes in geriatrics. Many symptoms in the elderly are very different. After 65, medicines react differently. Also a geriatrics doctor will assist with your loved one "making their own decisions" and dealing with delirium and confusion.
I find it frustrating with hospitalization and the changing of nurses and doctors on a daily basis. Many do not understand the elderly and will take your loved one off of all meds... and start over. Then you are dealing with withdrawl and confusion! It is important to use a patient advocate in that case. You should request one early on in the visit. Remember that is really not your Mom or Dad you are dealing with and "go with the flow" instead of reasoning or getting angry. This too will pass!
I agree, Stu, and my mom has a wonderful geriatrician. However, she does not have privileges at this particular hospital but was aware of what was going on. From my mom's recent hospital stays during the past 2 yrs, I certainly know how important it is for the patient to have an advocate for them, and there's no better person than me. I appreciate your comments.
The fact that your loved one's primary geriatrician is not a doctor at the hospital is quite common. Then at the hospital the doctor's are part of a group and change daily. Even they don't agree with each other.
We had one doctor take Mom off of all her meds and tell me to take her back to the primary to put he back on after he discharged her. That meant withdrawl, unnecessry pain, and many more appointments. It is like I have no life outside of caring for Mom. That is when i found out about an advocate. Mom was delirious and we both had a meltdown before they would listen to me.
I also care for my mother's older brother and my husband has health issues. I often wonder what happens to elderly people who do not have an advocate. The medical profession makes it extra hard on the advocate and then stop and tell you to take care of yourself!!!! If it was not so sad, it would be funny! I am in a support group and go for counseling. I strongly recommend both to every caregiver.
