Delirium: The Often-Missed Hospital Complication

Unrecognized delirium is common, especially in people with dementia, and can lead to complications and longer hospital stays.

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.

More ways to help avoid delirium in the hospital

Know what can cause delirium in the hospital

Delirium can result from any kind of stressor to the overall body, especially illness. Among the common causes:

  • Infection (such as urinary tract infection or pneumonia)

  • Blood-chemistry abnormalities (such as high blood sugar or sodium)

  • Dehydration

  • Excessive pain (such as after surgery or if pain medication is insufficient)

  • Medications, especially tranquilizers, sleep aids, and antihistamines

  • Other stressors (in an older adult, even such things as not having a hearing aid or glasses, disrupted sleep, or constipation -- all common during hospitalizations -- can trigger delirium)

What you can do to prevent hospital delirium

  • Stay at your loved one's side during hospitalization both day and evening, or arrange for someone else (another family member, a hired elder companion or personal aide to take shifts in your place. (You can go home when your loved one is asleep for the night to catch a few hours of needed zzz's.) Your presence and gentle reorienting about what's going on can be immensely comforting and reduce stress.

  • Familiarize yourself with the signs of delirium. Realize that they can vary from person to person; the key is a sudden change in mental or physical function for your loved one.

  • Make sure your loved one has glasses, hearing aid, dentures, and other personal devices after they're removed for tests or other procedures. Staffers may overlook this or be unaware of assistive devices, and the person with dementia may not think to request them -- and suffer needlessly.

  • Learn more prevention tactics

If your loved one experiences delirium in the hospital

Try not to panic if delirium does occur. Instead, step up your efforts to provide support and reassurance to your loved one. You can also ask the doctors for more details on how they plan to manage your loved one's delirium. If the delirium persists or seems to keep getting worse, ask about getting an inpatient consultation from a geriatrician, who specializes in older adults and therefore will be familiar with both delirium care and dementia care.

almost 4 years ago, said...

Delirium pushed my father over the cliff in th early 1970s. He went in for a monor hernia removal. My Mom kissed him goodnight and we came back inthe early morning to be prepared to take him home. We found him tied up in a wheel with a srtaight jacket on. He had spent the night in this wheel chair! He went into the Hospital knowing my Mom and me and they delived him back to us and he did not either my mom or me and was totally incontinent. He did all the driving prior to this Hospitalization and obviously was not able to drive upon his release. He never did recover. I researched and believed he had full Alzheimers; his life time doctor disagreed and said Alzheimers was a European disease and only effected young people. When he died in January 1985, I insisted on an attopsy; again his doctor said he just had old folks disease! UC Davis then phoned me and asked if they could keep his brain because this was one of the first Alzheimer's Brain they had seen! When My Mom years later went in for surgery, she wanted me with her 100% of the time out of fear that the same thing could happen to her ! Ray