What is delirium?
Delirium is an altered and confused mental state that develops over a short period of time and usually has a reversible cause, such as medication or illness.
It is characterized by a sudden change from mental baseline, fluctuating mental status, inattention, and disorganized thinking.
Delirium is very common, especially in older patients admitted to the hospital. About one third of patients over age 70 admitted to the hospital experience delirium.
What are the risk factors?
Older age, dementia, trouble performing daily activities, and multiple medical problems all put patients at higher risk of developing delirium.
Some examples of things that can cause delirium include surgery, medications, dehydration, infection, stroke, urinary retention, constipation, and heart problems.
Medications with especially high delirium risk include alcohol, medications for overactive bladder, antihistamines, sleeping pills, and anxiety medications.
Why is delirium significant?
Delirium is associated with poor patient outcomes. It has been linked to increased risk of death, institutionalization, and dementia.
Furthermore, delirium often goes unnoticed, so it is important for medical teams to actively prevent, recognize, and manage it.
What to expect if your loved one experiences delirium
Delirium is usually temporary, and improves as the precipitating cause is treated. However, symptoms may persist for weeks to months. Older age, worse cognitive function at baseline, and more severe illness are factors that make it harder for a patient to return to their previous mental baseline.
For patients with delirium or high risk of developing delirium, families are encouraged to stay with patients in the hospital and inform medical staff of any changes in mental status.
Management and Treatment
The best way to treat delirium is to prevent it from developing in the first place. Delirium can be prevented with simple guidelines.
The most effective ways to prevent delirium are shown below, in an excerpt from HealthinAging.org, a publication of the American Geriatrics Society.
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Once recognized, the most important treatment for delirium is to identify the underlying cause, and fix it if possible. For example, if a patient is delirious and if found to have a new urinary tract infection, the first step would be to treat the urinary tract infection.
The next step is to remove any factors that may be making delirium worse, and try to get the patient back to their normal routine. Patients should be discharged from the hospital as soon as it’s medically appropriate. In the meantime, patients should have a regular schedule of using the bathroom, quality sleep, and regular physical activity.
Having a family member at the bedside can help patients get reoriented and improve delirium.
Prolonged bed rest and sedating medicines can actually make delirium worse, and should be avoided whenever possible.
Sometimes, if a patient’s delirium is severe enough to put themselves or other people in danger, a small dose of a calming medication may be used.
For more on delirium, visit our page on dementia or visit https://www.healthinaging.org/a-z-topic/delirium
