Delirium and Dementia Recovery

4 Things to Know After Your Loved One Has a Bout of Delirium
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What can you expect in terms of recovery after your loved one with dementia has a bout of delirium? People with dementia often develop delirium (a state of worse-than-usual mental confusion) during the stress of an illness and when hospitalized.

Here's what to know next and what you can do about it:

1. After delirium: Know that it can take a long time to recover back to the old normal.

In principle, delirium is a reversible state of mental confusion. In people with dementia, however, it can take days, or even weeks, to return to predelirium mental abilities, even once the delirium triggers have been removed or treated.

What you can do

First, be patient. Although you may hear of others who bounced back quickly after delirium, you can't hurry recovery. Enlist added support for yourself to weather this period, which can make caregiving more taxing, such as hiring an in-home caregiver to help or having relatives spell you more often.

Provide supportive care. You can help your loved one recuperate by keeping his or her environment calm and consistent. Minimize visitors, including young family members who may not be remembered and may only add stress or confusion. Try to employ a small number of familiar in-home caregivers rather than a big, rotating cast of characters. Don't take your loved one out socially until things are stable. The least stressful setup now is a familiar home (or a hospital or facility room containing familiar objects) with a minimum of noise and fuss.

Encourage your loved one to move around. "Resting comfortably and calmly" doesn't mean confining him or her to bed. In fact, constant bed rest can make things worse in someone who's able to walk or move about. So do allow for mobilization, but under supervision. Support your loved one when he or she walks or changes position.

Keep an eye out for worsening mental state. The nature of delirium is to wax and wane, but the trend should be stable or improving. If you notice that confusion or other signs of delirium are worsening, or returning after an absence of time, don't hesitate to bring them to a doctor's attention. It's possible your loved one may have delirium again from a new cause, such as a medication side effect or a urinary tract infection.

2. After delirium: Realize that some people never recover to their previous mental abilities.

As is true of dementia in general, there's a lot of variability in how an individual may change after an episode of delirium.

Given enough time, and the removal of delirium triggers or their treatment, many people with dementia recover to what was normal for them before the delirium. Unfortunately, this isn't true for everyone. In some, mental decline accelerates after a bad episode of delirium.

What you can do

*Be optimistic but realistic. If it's been a while since the delirium has been treated, and your loved one with dementia has stopped improving, you may need to accept that there's a new, more impaired, normal. Of course, it can be hard to say whether the delirium created the decline or whether you're seeing the expected decelerating course of dementia. In either case, it's more productive to now focus on dealing with the new reality than beating yourself up with "if only's."

More of what to expect after delirium in someone with dementia

3. After delirum: Know that delirium is linked to future poor health outcomes.

In general, people who have suffered from delirium during a hospital stay tend to fare worse after discharge than those who didn't get delirious. This includes having a higher chance of being placed in a nursing home, a higher chance of losing the ability to do things for oneself, and a higher chance of dying within the next two years.

This is, in part, because developing delirium reflects a certain burden of illness and/or frailty -- the person who gets delirium may be in worse shape to start with. But it's also possible that delirium may cause some subtle damage to the brain.

What you can do

If your loved one has had delirium, especially during a hospital stay, consider it a warning that additional decline could be on the way. Someone who had been living independently with supports may no longer be able to do so. Or the person may need more help with the activities of daily living -- preparing meals, toileting, bathing, getting dressed -- than before.

Review advance-care planning. For example, look over the financial plans for when your loved one needs more care, and his or her medical preferences should the functional state become worse.

Think about whether you can handle added care demands under your current care plans, or whether you'll need more help. Explore, if you haven't already, in-home care or out-of-home placement options.

4. After delirium: Be on the lookout for future episodes of delirium, especially during a serious illness.

Having dementia places one at extremely high risk for developing delirium. On top of that, experts believe that those who have had delirium are likely to get it again the next time they're ill.

What you can do

Avoid medications likely to precipitate delirium. Common culprits are:

Anticholinergic medications, a class that includes drugs for overactive bladder, itching/allergy, vertigo, nausea, and certain drugs for nerve pain or depression. (Diphenhydramine, or Benadryl, is a commonly used anticholinergic often included in over-the-counter sleep aids and PM-version painkillers.)

Sedatives, tranquilizers, and antipsychotics.

Opiate painkillers. Note, however, that in people with dementia, geriatricians tend to use low doses of opiates to treat pain, which don't usually lead to delirium. Pain is common in older adults, and untreated pain can make a demented person more irritable, or even delirious, if it's severe pain such as fracture pain.

Learn the basic steps on how to prevent delirium before another illness strikes, and especially if your loved one faces hospitalization.