Dementia and Delirium

Signs of Delirium -- and What Dementia Caregivers Can Do
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If your loved one's sudden mental decline has been diagnosed as delirium, you should get a medical evaluation to look for underlying illness and to help identify the cause or causes of the delirium. But a caregiver's work in treating delirium doesn't end there.

People with dementia and delirium often take days (or sometimes longer) to return to their predelirium mental state. During this recovery time, pay extra attention to three sets of tasks:

Providing supportive care to the person with dementia

Managing any difficult behavior or problematic confusion

Making sure you have the added support you will need during this health challenge

How to provide supportive care for the person with dementia

Every additional physical, mental, and emotional stress will make it a little harder for your loved one's delirium to clear. To help minimize additional stresses, try the following:

Keep your loved one in a reassuring, familiar environment, with familiar caregivers. If your loved one has been hospitalized and is ready to be safely discharged, going to a familiar home may be less stressful than heading for a rehab facility or moving directly into an assisted-living location. If the person can't go home, bring home to him or her in the form of favorite blankets and photos or other homey touches.

Also, avoid a heavy rotation of new caregivers. One to three familiar faces are much less stressful than someone different every day, every shift.

Make sure eyeglasses, hearing aids, dentures, and other assistive devices are always available. Not being able to see, hear, eat, or walk properly is frustrating and stressful. People with dementia often forget to use even those devices they've had for a long time, so they may need to be gently reminded. Note that in the hospital, devices are often removed before procedures or tests; try to make note of the presence of these items throughout the day.

Make sure any pain is adequately treated. Watch your loved one for unarticulated signs of pain, such as wincing, loss of appetite, or favoring one side. Bring concerns to medical staff. Don't worry that your loved one will get "hooked" on pain meds. Untreated pain is a far more realistic concern, since it can actually worsen delirium.

Monitor your loved one for constipation. It may not seem connected to delirium, but it is. Both constipation and dehydration stress the body, and being constipated can be painful.

Keep up your loved one's favorite comfort measures. Everyone has different relaxation triggers. If your loved one seems to respond especially well to a certain kind of music, to massage, to time spent with a pet, and so on, lean heavily on those measures now. Use them frequently through the day.

Make sure the room is a comfortable temperature. It should be neither too cold nor too warm. Cozy socks can feel good in a cool hospital room. Just be sure your loved one doesn't try walking across the floor in them (they're a falling hazard).

More ways to care for someone with dementia who shows signs of delirium

How to manage difficult behavior or problematic confusion

The additional confusion of delirium often puts an older adult with dementia at increased risk of falls. You may also notice that anxious or aggressive behaviors get worse (although sometimes delirium causes the opposite: a quieter and depressed-seeming person).

Try the following:

Practice timed toileting. Making regular reminders and trips to the bathroom will minimize incontinence. Your loved one may no longer be paying attention to body cues to use the bathroom, which means accidents can increase.

Stay calm. It's only human to respond to strong emotions with strong emotions, but doing so can be like adding kerosene to leaping flames. A soothing environment in which the person with dementia feels safe can go a long way toward minimizing difficult behaviors.

Avoid restraints for agitation. They're still sometimes recommended for aggressive outbursts by people with dementia; unfortunately, restraints often, paradoxically, make things worse. What works better: Try to talk down the person with a calm, easy voice. Don't try to reason or rationalize; simply acknowledge the distress and then redirect the behavior.

Get help if the situation deteriorates. The best tools for coping with physical aggression are behavioral. If all else fails, doctors sometimes use low doses of an antipsychotic drug such as Haldol or Risperdal. But they should only be used as a last resort, since these drugs increase the risk of falls. (Beware of tranquilizers such as Valium and Ativan, which may make delirium worse.)

How to line up the extra support you may need while treating delirium and its recovery

Assess where things stood before the delirium. If you were managing all right, you'll still need extra reinforcements, because managing delirium care can be taxing, given how unpredictable recovery can be. If you were already struggling, know that this may be the tipping point.

Think both short-term and long-term when it comes to relief. It's no longer a good idea to leave your loved one alone for periods, even if this worked out fine before. Nor do you want to bring even a mobile loved one out with you on errands -- it's too stressful right now. So you'll need to be relieved for things such as shopping and running other errands. And because the cumulative stress can be difficult, you'll also want to get away for longer stretches, even once your loved one appears to be on the mend -- or if the "new normal" after delirium is an increase in cognitive problems.

Consider an elder companion. Available from in-home care agencies, these professionals can be a good option for help in keeping a watchful eye on a loved one who doesn't need much nursing care. Some caregivers hire them during the day while they work; others set up set hours during the week so they can get breaks.

Call on your reserve helpers. Many caregivers have a network of family and friends who vaguely ask to be called "if you need anything." This is one of those intensive periods where it's smart to cash in those chips. Even having someone pick up groceries or dry cleaning, or do your laundry, are huge helps that free you up to provide calming, loving companionship during delirium recovery.