I’ll never forget the terror in my grandma’s voice when she told us about the man who had come into her hospital room in the middle of the night. Grandma’s vivid hallucinations seemed real to her. Normally very sharp, she was confused and frightened. The nurse said confusion was common after surgery and was probably due to my grandmother’s age (74 years).
Hospital delirium isn’t dementia and it isn’t normal. About 75% of intensive care unit (ICU) patients, regardless of age, experience it while in the hospital and have symptoms of Alzheimer’s or traumatic brain injury a year later, according to researchers at Harvard and Vanderbilt Universities. It afflicts about 1/3 of patients 70 years and older who are not ICU patients.
Delirium is characterized by sudden and frequent changes in cognitive ability, delusions and hallucinations, shifting attention, and incoherence. People react differently, either becoming agitated and belligerent or sleepy and lethargic. Delirium’s sudden and fluctuating symptoms distinguish it from dementia.
Ignoring the condition can result in falls during the hospital stay and lead to long-term mental and physical decline. Suffering with delirium is similar to post-traumatic stress disorder affecting combat veterans.
Dr. Sharon Inouye, Harvard Medical, believes 40% of hospital delirium is preventable. Since the use of large doses of anti-anxiety drugs (benzodiazepines) and sleep-disrupting hospital routines are thought to be key causes, forward-thinking medical facilities are working to reduce these, and increase patient movement as early as possible after procedures.
Families can help to reduce a loved one’s confusion while in the hospital by focusing on orientation and companionship.
1. Arrange shifts for 24-hour attendance with family or professional caregivers to help with calming assurances and to observe behavior changes which might indicate delirium, such as delusions. (Report concerns immediately to medical personnel).
2. Calmly reassure your loved one where he or she is and why.
3. Keep information and instructions one task at a time.
4. Help them get enough fluids and to eat (make sure they have their dentures).
5. Keep senses engaged; bring glasses and hearing aids, give hand and foot massages, play favorite music at soft levels.
6. Support orientation further with a large clock with numbers and other recognizable personal items, such as familiar blankets, and family photos.
7. Open window curtains in the daytime and close them at night. Request doctor’s orders for 5 hours of unbroken sleep at night.
8. Support exercise: Help him or her use the bathroom, rather than a bed-pan and walk down the hallway to meals, rather than eat in the room.
Research shows the devastation delirium can cause and hospitals are responding. Large hospital systems, like Nebraska Medicine and Methodist in Omaha, are creating patient-centered medical teams to treat older adult and training medical personnel in recognizing and preventing delirium. Familiar caregivers will remain an important part of stopping delirium, since they are likely to recognize its symptoms first.