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Family Health Magazine - growing older

Seniors & Delirium
A medical emergency

If someone you know is suddenly confused and has trouble concentrating, this could be delirium. Delirium is confused mental functioning. Older people are at greater risk for developing the condition. It is absolutely essential that delirium be treated quickly. It is a medical emergency.

Delirium is a change to a person’s usual functioning, and develops over a day or a few days. Someone who usually manages well may suddenly not be able to do simple tasks or have a conversation that makes sense.

A person who is usually mentally sharp may not know where he or she is, or what year it is. Those with delirium can first be agitated or worried, and then unusually sleepy and sluggish.

Keep in mind that both delirium and dementia can look like confusion. However, they are different illnesses.

Delirium has many causes. It may accompany a physical illness like pneumonia or a stroke. Medications could be the problem. It could also be the first warning of medical illness. Delirium affects nearly a third of people admitted to hospital. Depending on the cause, delirium may range from a short episode to a few days, but can even last weeks or months.

Regardless of the cause, delirium is a serious medical condition. Recognizing and treating it early is essential. Family and friends play an important part in helping a confused person to recover. Delirium is usually reversible, and prompt treatment improves recovery.

Table 1 - Dementia vs. Delirium

	Delirium
Drugs	taking many medications recently starting or stopping medication changes in medication dosage over-the-counter medications herbals alcohol
Electrolytes	minerals in the body are out of balance dehydration can be a factor
Lack of drugs	stopping certain medications alcohol withdrawal
Infection	examples include urinary or respiratory tract (system) infections like a bladder infection or pneumonia, or blood or wound infection after an injury or surgery
Reduced sensory input	poor or uncorrected vision or hearing can reduce sensory stimulation
Intracranial (problems in the brain)	causes include stroke
Urinary or bowel problems	being unable to empty the bladder or bowel can contribute
Myocardial (heart) and lung problems	causes include heart attack, pneumonia, or other condition that causes a lack of oxygen in the blood and the brain

Table 2 - Causes of Delirium

	Dementia	Delirium
Appearance	slow onset over months or years	sudden onset over hours or days
Course	progressive	fluctuating (changes)
Speech	normal	rambling
Attention	normal	trouble paying attention, easily distracted
Memory	gradual and progressive memory loss	changing
Hallucinations	possible	common, especially visual (seeing things that are not there)
Level of alertness	normal	abnormal
General health	usual	signs of illness or drug side effects

What does delirium look like?

If you suspect someone is delirious, look for the following signs.

• A sudden, fluctuating condition
• Delirium appears suddenly, and worsens over hours or days.
• It can change, with periods of agitation and restlessness.

Impaired attention

• The person has difficulty paying attention or concentrating on conversation.
• Familiar tasks are challenging.
• Being easily distracted makes it hard to follow simple commands.

Disorganized, confused thinking

• Delirious people may not know where they are, or what day it is.
• They may not remember the meaning of words. Speech may be rambling or jumbled, and not make sense, as with “I have lost the B from the alphabet.”
• They may do things that do not make sense or are unsafe, such as turning on all the stove elements and walking away.

Suspicion or paranoia

• The person is unusually anxious – for example, being afraid of someone hiding in the closet, or thinking that health care providers are not to be trusted.
• Hallucinations are a possibility – for example, seeing mice running on the floor, thinking call bells in the hospital are a choir practicing, or feeling like the bed is on the ceiling

Changing level of consciousness (alertness)

• In hyperactive delirium, the person is agitated. Mood swings and angry, belligerent, or aggressive behaviour towards caregivers are all possible. For example, after surgery the person may try to climb out of bed, yell at caregivers, or pull out a catheter and IV lines.
• Hypoactive delirium is the opposite, appearing as extreme drowsiness, fatigue, and lethargy. These episodes may be misinterpreted if caregivers believe the person is just ill or resting.

Risk factors

Certain factors make some people more likely to develop delirium:

• advanced age
• impaired mental function or dementia – older people with dementia are especially at risk
• a history of previous episodes of delirium
• having many medical conditions
• taking many medications
• severe stress, such as a move to a new environment, recent injury or surgery
• too little sensory stimulation.

A lack of sensory stimulation may appear if a person cannot see and hear well, or is socially isolated. Not wearing glasses or a hearing aid can contribute to the problem.

The difference between delirium and dementia

As dementia and delirium share some common features, know how to tell them apart (see table). Dementia is a chronic, slowly progressing loss of memory and function. In contrast, delirium develops quickly. It warns of a serious underlying medical condition.

Get medical help

Noticing and treating delirium early is critical. This condition is a sign of a serious underlying medical condition. Older people with delirium are also at risk for injuries, falls, dehydration, pressure sores, and malnutrition.

Of course, being confused can also lead to dangerous actions.

Delirium is a medical emergency. If someone you know shows signs of sudden confusion, call the doctor or go to the emergency department.

How can you help?

Remember, someone who is confused cannot describe the problem. Medical professionals may not know how that person normally functions. You play an important role by explaining changes in behaviour.

Be ready to provide the following information:

• past medical problems
• current medication list
• history of any previous times of delirium and the cause, and head injuries
• details of everyday functioning and thinking before the confusion.
• You can also help ease the symptoms of delirium.
• Understand that the person cannot help how they are talking and behaving.
• Talk to the person calmly. The sound of your familiar voice can be reassuring.
• Help the person to eat and drink, whether at home or at the hospital. Assist with physical activity if the person is able.
• If the person usually wears glasses or hearing aids, make sure they are used.
• Have a calendar and clock in the room.
• Have appropriate lighting for the time of day.
• Keep the environment calm, quiet and uncluttered.
• Protect the person from hazards, such as falling, and from doing things that are not safe.
  

It can be upsetting when someone you care about is confused, and not speaking or behaving as they normally would. However, you are key to spotting the condition and ensuring that it is treated. If you suspect someone you love is delirious, get medical help as soon as possible.

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