Tips on tackling hospital-induced delirium

An estimated 7 million Americans experience delirium at the hospital every year. It is a condition affecting the elderly that goes undiagnosed 60% of the time and can prove deadly.

However, there are ways we can help protect our loved ones.

A recent stay at the hospital for an emergency surgery had Rolland Pfile terrified.

He says, "Almost anything that I heard, I was interpreting as a death threat."

Rolland was suffering from delirium, a sudden alteration in mental state affecting about 80% of patients on mechanical ventilation in the ICU.

"If I'd have gotten a hold of a weapon, I would have started firing."

Dr. Malaz Boustani from Indiana University’s School of Medicine says, “Delirium is acute brain failure."

Dr. Boustani says it can be just as serious as having a heart attack.

"Your chance of death over the next 30 days doubles."

It does not stop there.

"Your chance of developing full blown Alzheimer's disease over the next 5 years goes up two, sometimes five times the odds."

While the exact cause of delirium is not known, for vulnerable older people, developing a urinary tract infection or taking an over-the-counter sleeping pill could lead to it. A stroke or heart attack could also trigger delirium. In about 40% of cases, hospital-acquired delirium is preventable.

Here is what you can do to help your loved ones: Have a list of all the patient's medications. Overmedication can trigger delirium.

Bring their glasses and hearing aids.

Watch for obvious signs like confusion.

"One hour, the patient is back to normal, another hour, the patient is more confused. This fluctuation is a red flag."

Finally, make things familiar by bringing comforting objects from home to help orientate them.

These are tips Rolland's wife, Laverne, wished she had known sooner.

She says, "I knew nothing about delirium. I didn't have a clue."

Until recently, hospital-acquired delirium was chalked up to old age and not considered a condition to be prevented or treated.

Delirium patients also end up in nursing homes 75% of the time, which is five times higher than those without the condition.

The condition also leads to longer stays in the hospital, an average of nine days compared to four without delirium, costing patients an average $60,000 per hospital stay.

RESEARCH SUMMARY

BACKGROUND: Delirium can be defined as a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. The onset of delirium is often sudden, usually developing within hours or days. The exact cause of delirium is unknown, but can sometimes be traced to a few contributing factors such as medication, a severe or chronic medical illness, surgery, or drug or alcohol abuse.

SIGNS OR SYMPTOMS TO WATCH OUT FOR: Signs and symptoms can be similar to dementia, making input from a family member important when determining the diagnosis. Since onset of dementia is often sudden, symptoms fluctuate throughout the day. A few primary symptoms include:

• Cognitive impairment, or poor thinking skills: Difficulty reading or writing, poor memory, particularly of recent events, difficulty understanding speech, difficulty speaking or recalling words, disorientation, or not knowing where one is, who one is, or what time of day it is rambling or nonsense speech.
• Reduced awareness of the environment: Inability to stay focused on a topic, wandering attention, being easily distracted by unimportant things, getting stuck on an idea rather than responding to questions or conversation.
• Other common symptoms: seeing things that don't exist (hallucinations), disturbed sleep habits extreme emotions, such as fear, anxiety, anger or depression, agitation, irritability or combative behavior.

Elderly people who are recovering in the hospital or living in a long term care facility are particularly vulnerable to delirium. Approximately seven million Americans experience delirium at the hospital a year, and is undiagnosed 60% of the time.

VULNERABILITY: Delirium occurs when normal receiving and sending brain signals are impaired. The impairment is not exactly known, but a combination of factors could be involved. For example, a patient is more vulnerable when they experience dementia, limited ability to perform everyday activities, severe terminal illness, have HIV/AIDS, abuse drugs or alcohol, have poor nutrition, of older age, or have visual or hearing impairment. Medications, surgery, sudden illness, multiple medications, infection, use of recreational drugs, emotional stress, admission to ICU, and multiple medical procedures are all triggers for delirium in people who are more vulnerable.

WHAT YOU CAN DO: The first goal of treatment for delirium is to address any underlying causes or triggering factors - by stopping use of a particular medication, for example, or treating an infection. Treatment then focuses on creating an optimal environment for healing the body and calming the brain, but it is very important for loved ones to help in the treatment. In order to help loved ones, a person must have a list of all prescriptions and over-the-counter medications, as well as dietary supplements, the patient takes because overmedication can trigger delirium. They must be able to provide the names and contact information of all doctors. It is also important to record the time of onset and a description of
symptoms (if onset occurs before they are hospitalized). They need to bring the patients glasses or hearing aids. Finally, a person should brings things familiar from home to help orientate them (Source: www.mayoclinic.com).

For More Information, Contact:

Cindy Fox Aisen
Regenstrief Institute
Indiana University
caisen@iupui.edu


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