Delirium

Delirium is a sudden, serious change in how someone thinks and understands their surroundings. It causes confusion and disorientation, and it usually develops quickly, over a few hours or days.

There are many reasons why someone might experience delirium. These could include a serious illness, either short-term or long-term, or a chemical imbalance in the body, like low levels of sodium. Other causes can be certain medications, infections, surgery, or the use or withdrawal from alcohol or drugs.

Sometimes, the symptoms of delirium are similar to the symptoms of dementia. Doctors often rely on information from family members or caregivers to help them distinguish between the two. This is because the family can provide crucial insight into the person's usual behavior and how their condition has changed.

Delirium: Understanding the Symptoms and How to Help

Delirium is a sudden change in a person's mental state. It usually starts over a few hours or days and is often linked to an underlying medical problem. These symptoms can come and go throughout the day, sometimes disappearing for periods, but are often worse at night or in unfamiliar places like a hospital.

Common Symptoms of Delirium:

Delirium can affect many areas of thinking and behavior, leading to:

• Trouble concentrating and switching thoughts: A person might have difficulty focusing on a conversation, get stuck on one idea, or easily lose their train of thought.
• Changes in alertness and activity: Someone might be very withdrawn and inactive, or conversely, restless and agitated. This can range from seeming drowsy to being very active and combative.
• Memory problems: This can include forgetting recent events, not knowing where they are or who they are, or difficulty remembering words.
• Communication problems: Trouble speaking, finding words, understanding speech, reading, or writing are also common.
• Mood swings and emotional changes: These can include anxiety, fear, depression, anger, feeling overly happy, a lack of emotion, or sudden shifts in mood.
• Hallucinations: Seeing or hearing things that aren't there.
• Changes in sleep patterns: A person might have trouble sleeping at night or be awake during the day.

Types of Delirium:

Doctors often categorize delirium into these types:

• Hyperactive Delirium: This is often the easiest to recognize. People with this type are often restless, pacing, anxious, have rapid mood swings, and might see things that aren't real. They may also resist being cared for.
• Hypoactive Delirium: In this type, a person is inactive or has reduced activity. They might seem sluggish, drowsy, or in a daze, and may not interact with others.
• Mixed Delirium: This involves symptoms of both hyperactive and hypoactive delirium, with the person switching between these states.

Differentiating Delirium from Dementia:

Delirium and dementia can have overlapping symptoms, making them difficult to distinguish. Dementia is a gradual decline in memory and thinking skills due to brain damage. Alzheimer's disease is a common cause.

Key differences include:

• Onset: Delirium develops quickly (within a day or two), while dementia develops gradually over months or years.
• Attention: Delirium affects a person's ability to focus, while people with early-stage dementia usually remain alert.
• Fluctuation: Delirium symptoms can change rapidly throughout the day, while dementia symptoms typically remain relatively consistent.

What to do if you suspect delirium:

If you notice these symptoms in a loved one, or someone in your care, talk to their doctor immediately. Your observations about their typical behavior, usual abilities, and the onset of symptoms will be crucial for diagnosis and finding the underlying cause. If you notice these symptoms in someone in a hospital or nursing home, report your concerns to the staff. Older adults in hospitals or long-term care facilities are at a higher risk of experiencing delirium.

If a family member, friend, or someone you're caring for seems confused or disoriented (showing signs of delirium), talk to their doctor right away. Your observations about how they usually think and act are crucial for the doctor to understand what's happening. This helps the doctor figure out the cause of the confusion.

If you notice these symptoms in someone in a hospital or nursing home, tell the nurses or doctors. Sometimes, staff might not notice the changes in someone's condition, especially older adults. Hospitalized older adults and those in long-term care facilities are more likely to experience delirium. It's important to share your observations with the medical team to help identify and treat the problem as quickly as possible.

Delirium happens when the brain's communication system isn't working as it should. This means signals aren't being sent and received correctly. This can have many different causes, sometimes just one, and sometimes several working together.

There are many potential reasons for delirium:

• Medications: Taking certain medicines, or a combination of medicines, can lead to delirium. These include drugs for pain, sleep problems, allergies, asthma, swelling, Parkinson's disease, spasms, or seizures. Even seemingly harmless medications can sometimes have unexpected side effects that cause delirium.

• Medical Conditions: Underlying health problems can trigger delirium. This includes things like strokes, heart attacks, worsening lung or liver disease, injuries, and infections. For example, a severe illness or one that's expected to be life-threatening can sometimes lead to delirium.

• Substance Use and Withdrawal: Alcohol or drug use, or stopping the use of these substances (withdrawal), can cause delirium.

• Body Imbalances: Problems with the balance of substances in the body, such as low sodium or low calcium levels, can also cause delirium.

• Infections: Fevers and infections, especially urinary tract infections, pneumonia, the flu, or COVID-19, can cause delirium, particularly in older adults and children.

• Environmental Factors: Exposure to harmful substances like carbon monoxide, cyanide, or other poisons can cause delirium. Poor nutrition, dehydration (losing too much body fluid), and lack of sleep can also contribute.

• Emotional and Physical Stress: Severe emotional distress or prolonged pain can contribute to delirium. Major surgery or other medical procedures that require general anesthesia can also temporarily cause delirium.

It's important to remember that delirium can result from a combination of factors. Sometimes, no clear cause is found. If you or someone you know is experiencing delirium, it's crucial to seek medical attention to identify the cause and receive appropriate treatment.

Hospital stays can raise the risk of delirium, a condition that makes it hard to think clearly. This is especially true for people recovering from surgery or those in intensive care. Older adults and people in nursing homes are more prone to delirium.

Several other factors can also increase the chances of developing delirium:

• Brain problems: Conditions like dementia, stroke, and Parkinson's disease can make a person more likely to experience delirium.
• Previous delirium: If someone has had delirium before, they're at a higher risk of having it again.
• Sensory issues: Vision or hearing loss can make it harder to stay focused and oriented, increasing the risk of delirium.
• Multiple illnesses: Having several medical problems at once can put a strain on the body and brain, increasing the chance of delirium.

Delirium can be a temporary state of confusion, lasting anywhere from a few hours to several weeks or months. If the reason for the delirium is treated, recovery can happen more quickly.

How quickly someone recovers from delirium depends on their health and mental abilities before the confusion started. For example, if someone already has dementia, they might have a harder time remembering things and thinking clearly after the delirium episode. People who were healthier before the delirium is more likely to fully recover their normal mental abilities.

Unfortunately, people with serious, long-term, or life-threatening illnesses might not get back all their mental sharpness after a delirium episode. In these cases, delirium can make things worse. For example, delirium in very ill people may lead to:

• A general worsening of their health
• A slower recovery from surgery
• A need for ongoing care in a nursing home or similar setting
• A higher chance of dying.

Preventing delirium, a state of confusion, is often about addressing the things that can cause it. Hospitals are tough places to avoid delirium because of many changes and disruptions. Patients may be moved to different rooms, get various medical procedures, and be exposed to loud noises and dim lighting. A lack of natural light and not getting enough sleep can worsen confusion.

Fortunately, there are steps to help prevent or lessen delirium. These include encouraging good sleep routines, keeping the person calm and oriented to their surroundings, and preventing other medical issues. It's also important to avoid medications that cause sleepiness, like diphenhydramine (often found in allergy or sleep aids like Benadryl or Unisom). By taking these steps, we can help people stay more focused and less confused during their hospital stay.

Doctors can figure out if someone has delirium by looking at their medical history, doing mental status tests, and considering possible causes. They'll also do a physical exam.

To understand what's happening, a doctor will:

• Review medical history: The doctor will ask about recent changes in the person's health. Did they get a new infection? Start a new medication? Experience a new injury, pain (like chest pain), headache, or weakness? Have they used alcohol or drugs (prescription, illegal, or recreational)? These recent changes are important clues.

• Assess mental status: The doctor will check how aware, focused, and clear the person's thinking is. This might involve a conversation, or specific tests to measure attention and thinking skills. Information from family members or caregivers can be very helpful in this process.

• Do a physical and neurological exam: A physical exam looks for signs of other health problems, like infections or diseases. A neurological exam checks things like vision, balance, coordination, and reflexes. This helps determine if a stroke or another medical condition might be causing the delirium.

• Order other tests: The doctor might need blood tests, urine tests, or other lab work. If the cause isn't clear from the other information, brain scans or other imaging tests might be necessary to get a better picture of what's going on.

Dealing with Delirium: A Guide for Caregivers

Delirium is a state of confusion and disorientation that can affect anyone, especially older adults or those recovering from illness. The first step in treating delirium is to find and fix the underlying cause. This might involve stopping certain medications, treating an infection, or correcting a problem with the body's balance. The goal is to create a calm and supportive environment for the body to heal and the brain to settle.

Supporting the Person:

The focus of care is to prevent problems from arising. Here's what you can do:

• Safety First: Protect the person's airway.
• Nutrition and Hydration: Ensure they get enough fluids and nutritious food.
• Gentle Movement: Help them move around safely and gently.
• Pain Management: Treat any pain they're experiencing.
• Bladder Control: Address any issues with bladder control.
• Avoid Restraints: Never use physical restraints or catheters unless absolutely necessary.
• Stable Environment: Keep the surroundings and caregivers consistent to avoid confusion.
• Familiar Faces: Include family members or familiar people in their care to provide comfort.

Medications:

If a loved one is experiencing delirium, talk to their healthcare provider about any medications that might be contributing to the problem. The doctor might suggest stopping certain medications, reducing doses, or prescribing different medicines for pain or agitation. They might also be prescribed medication to help with fear, distrust, or hallucinations. These medications are usually only used when:

• The symptoms make medical care difficult.
• The person or others are at risk of harm.
• Other treatments haven't helped.

Once the symptoms improve, the doctor will likely reduce or stop the medication.

Preventing Delirium:

If someone is at risk of delirium, there are steps you can take to help prevent an episode. Similarly, following these steps can help those recovering from delirium to heal and prevent future episodes.

Promoting Well-being:

• Sleep Hygiene: Create a calm, quiet sleep environment with appropriate lighting and a regular schedule. Encourage daytime activity to promote restful sleep at night.
• Mental Clarity: Keep a clock and calendar visible and use them to schedule activities. Explain changes in routine clearly and simply. Maintain a familiar environment with comforting objects, but avoid clutter.
• Gentle Communication: Approach the person calmly and introduce yourself and others. Avoid arguments. Use touch or other comfort measures if appropriate. Minimize noise and distractions. Make sure they have their eyeglasses and hearing aids.

Maintaining Health:

• Medication Management: Ensure medications are taken as prescribed.
• Nutrition and Hydration: Provide a healthy diet and plenty of fluids.
• Physical Activity: Encourage regular, gentle physical activity.
• Prompt Medical Attention: Seek prompt medical care for any new or worsening problems, like infections.

Taking Care of Yourself:

Caring for someone with delirium can be emotionally and physically demanding. Don't forget to take care of yourself:

• Support Groups: Join a support group for caregivers.
• Education: Learn as much as you can about delirium.
• Resources: Ask your healthcare provider, local organizations, community health services, or government agencies for information and resources.
• Sharing the Load: Share caregiving responsibilities with family and friends who are familiar to the person.

Delirium can be challenging, but with the right support and care, both the person experiencing delirium and their caregivers can get through it.

Taking Care of Someone at Risk for Delirium

If you're helping someone who might get delirium, there are things you can do to help prevent it or to help them recover. Delirium is a state of confusion and disorientation. It can happen to anyone, but it's more common in older adults and those recovering from illness.

Preventing Delirium:

• Good Sleep Habits: A consistent sleep schedule is key. Make sure the environment is calm and quiet. Use soft, warm lighting that changes throughout the day to mimic natural daylight. Encourage the person to be active and engaged during the day. This will help them sleep better at night. A regular schedule will help them feel more in control.

• Promoting Calmness and Orientation: Keep things familiar. Put up familiar pictures or objects, but avoid clutter. Use a clock and calendar, and refer to them often. Explain changes in routine simply and clearly (e.g., "It's time for lunch now"). Introduce yourself and others calmly. Avoid arguments or raising your voice. A gentle touch can be comforting. Keep noise and distractions to a minimum. Make sure they have glasses and hearing aids if needed.

• Preventing Medical Problems: Make sure the person takes their medicine as prescribed. Encourage them to drink plenty of fluids and eat healthy foods. Regular exercise is important. If you notice any signs of illness, like a fever or infection, get them to a doctor right away. Prompt medical attention is crucial.

Caring for Yourself:

Caring for someone with delirium can be really stressful. It's important to take care of yourself too. Join a support group for caregivers. Talk to your doctor or other healthcare professionals for more information and resources. This might include pamphlets, websites, or local organizations. Ask family and friends to help share the caregiving responsibilities so you can get breaks. There are many organizations that can offer support and information, such as the Caregiver Action Network and the National Institute on Aging. Don't be afraid to ask for help.

Key Takeaways:

• Consistency: A regular schedule helps the person feel more secure and oriented.
• Clarity: Simple, clear communication is essential.
• Comfort: A calm, familiar environment and gentle touch can be very helpful.
• Health: Ensuring proper medications, fluids, nutrition, and medical attention is critical.
• Self-Care: Taking care of yourself is just as important as taking care of the person with delirium.