Jan 19, 2017

Caring for the Elderly Who Have Delirium

Delirium in the elderly displays a lot of the same symptoms as dementia or perhaps the onset of Alzheimer’s, except it is usually temporary and treatable.

There are multiple risk factors which make elderly people more susceptible to delirium. It is impossible to list all of the conditions and stressors that may lead to delirium, but the chances of developing delirium increases when a patient has a high number risk factors. Delirium is often the only sign of an underlying serious medical illness in an elderly patient, which is why particular attention should be made when identifying and correcting these factors.

It is worth remembering that delirium can be preceded by a period of prodromal illness where the patient may appear anxious, restless, distracted, develop urinary incontinence or start refusing investigations. This usually lasts from around one to three days. It is very difficult to detect prodromal illness clinically, however family members are able to give a history of this prodromal period when the patient is being examined. Apart from the behavioural changes, elderly patients with delirium often do not look ill.

What to look for with delirium?

Look for the following symptoms of delirium for caregivers and health professionals to look for.

  • Is your loved one less alert or reacting more slowly?
  • Has there been an obvious change in activity or lack of activity?
  • Is your loved one experiencing sleeplessness or sleeping more than usual?
  • Are your loved one’s emotions different to normal? This includes anger, anxiety, depression and other emotions.
  • Has there been any instances of incontinence?
  • Is he or she more confused than normal? ie. are they saying or doing things out of character?

Is Delirium treatable?

Treatment of delirium is targeted towards changing or undoing the source of the condition. Depending on the reasons for the delirium your loved one might be admitted to a hospital for a short time, for observation, safety or to undergo treatment that cannot be resolved at home and need closer monitoring in the hospital.

Delirium is generally at least partially reversible if the cause of the delirium can be identified and treated promptly.

When an elderly patient is admitted to hospital and exhibits confusion, it should be presumed that they have delirium until proven otherwise. Studies have shown that 30% to 67% of patients with delirium go undetected.

As explained early on, Delirium is quite similar to the initial characteristics of dementia or Alzheimer’s. This is why any symptoms that present should be reported and then watched carefully so that an accurate diagnosis and necessary treatment can ensue. People with dementia can also develop delirium.

Delirium usually only extends for around a week, but in some cases may take more than a few weeks for a patient to return to what they believe to be how they felt and functioned before the episode began. Complete recovery is common and realistic to expect.

Caregiver may need to provide additional support in the following areas:

  • Due to altered cognition this can lead to self-neglect which would need to be monitored and assistance provided until recovery.
  • Your loved one may need additional support with daily activities such as toileting, feeding and personal hygiene.
  • Medication will need to be monitored more closely for correct dosing and use.
  • There is the danger of a loss of consciousness. Supervision is necessary to see that this doesn’t happen while your loved one is alone.

Studies have shown that nearly half of patients with delirium are discharged from the acute hospital setting with persistent symptoms and of these, 20-40% still have delirium at 12 months. Delirium can sometimes present itself more than once and more often the older a person gets older. Watch for the symptoms and know the course of action to take as soon as it’s noticed for the best possible outcome.

Educating ourselves in advance about possible conditions commonly experienced by the elderly will ensure timely and safe care is given to them when the need it. After all you know your loved one and their personality better than anyone.

 

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