When I was studying for my master’s degree in gerontology, I learned about delirium and thought about how tragic a condition it is for many older people and how confusing for all those around them. Delirium can occur after an
When I was studying for my master’s degree in gerontology, I learned about delirium and thought about how tragic a condition it is for many older people and how confusing for all those around them.
Delirium can occur after an operation, or sometimes as a consequence of a serious or sometimes not-so-serious (initially) medical condition. It is defined by the American Psychiatric Association as “a disturbance of consciousness and a change in cognition that develops over a short period of time.”
In other words, delirium is a sudden or acute reversible decline in attention and ability to think clearly. People stricken with delirium may become agitated or sluggish and lethargic. Sometimes they have hallucinations and other times the person may be peaceful and give the mistaken impression that nothing is wrong.
Sometimes the symptoms can swing from the hyperactive hallucinating end of the spectrum to the listless and lethargic end.
The causes of delirium are many. Older people with dementia, pre-existing chronic diseases such as kidney failure, alcoholism, depression, dehydration, malnutrition and drug usage may be more susceptible to dementia than their healthier peers.
Additional issues such as pain, medication usage, an acute infection or medical condition, surgery, urinary infection or the use of a catheter, or even psycho-social events, can tip the balance and bring on delirium, which can be life threatening.
Even living in a nursing home has a risk factor. According to government statistics, up to 40 percent of nursing home residents will experience delirium, usually from an infection.
Interestingly, in older people, signs and symptoms of many medical conditions do not present with textbook symptoms.
Many times older people do not have the expected high white blood cell count or fever that one would expect with an infection, but what is seen instead is the confused state of delirium. A very confusing and tragic situation to be sure.
It is estimated that around 30 percent of older people treated in the emergency department have delirium, but that physicians correctly diagnose delirium in only 24 to 35 percent of elderly patients. In many studies, elderly patients are discharged with no consideration that their confused state could signify a serious underlying medical condition.
Other studies show that failure to detect delirium in elderly patients leads to increased death rates within a short time after hospital discharge.
Many experts believe that all elderly patients should be given mental screening tests when first admitted, or be seen by an emergency room doctor to rule out delirium because of the high risk of death should it go undetected and underlying conditions go untreated.
Cognitive impairment is not a normal part of the aging process, and sudden onset of confusion is a tip off that delirium may be present.
Dementia is distinguished from delirium by the suddenness of the onset. Dementia develops over months and years, whereas delirium is sudden, usually within hours or days after surgery, infection, dehydration or other medical conditions.
Delirium is managed by providing a calm environment, preferably with family members and friends present and treatment of the underlying causes such as an infection or fluid imbalances.
Most causes of delirium are readily reversible; however, if it is not diagnosed and treated promptly, delirium in elderly people can result in increased sickness and death.
• Jane Riley, M.S., B.A., C.P.T., Certified Nutritional Adviser, can be reached at janerileyfitness@gmail.com, 212-1451 or www.janerileyfitness.com.
