Have you ever cared for a patient who is more quiet or reserved than usual? You might be tempted to think they are ‘the perfect patient,’ but the source of their unusual behavior could be delirium.

Delirium is a sudden change in a person’s mental state that makes them act or think differently than normal. It is often characterized by fluctuating episodes of confusion, memory loss, sudden mood changes and either restlessness, sleepiness or indifference. In some cases, delirium can even cause paranoia and hallucinations.

Wednesday, March 15, was the very first ‘World Delirium Day.’  Started by iDelirium, an international organization of delirium advocacy groups, the goal of the event is to raise awareness about this misunderstood syndrome that affects one in four older hospital patients.

Since its founding in 2011, Hartford Hospital’s ADAPT team (Actions for Delirium Assessment, Prevention and Treatment) has created programs and learning opportunities to combat delirium. ADAPT’s mission is to implement an evidence-based care pathway and monitor outcomes for patients facing or at risk of experiencing delirium.

“The most important part of prevention is making sure you avoid doing the wrong thing,” said Christine Waszynski, DNP, RN, GNP-BC. “Delirium can be caused by medications that are usually harmless. For example, we give many patients Pepcid to prevent stress ulcers, but if you give Pepcid to a sick 90-year-old, your risk of giving them delirium is extremely high. That’s why education is very important.”

Older adults and people who are very ill are at the highest risk of delirium, but it can affect anyone. It can last anywhere from a few hours to a few weeks or more.

Delirium is often caused or accompanied by illnesses and injuries. Unfortunately, it may show up early and stick around long after the underlying acute condition has been treated. “Delirium is like an unwelcome guest,” Waszynski said. “It is often the first guest to arrive and the last one to leave.”

Up to 45 percent of patients who develop delirium during a hospitalization have not yet returned to baseline mental status at the time of transition home or to a rehabilitation facility.

Patients with delirium often benefit from mobilization and socialization. Supportive families can help by spending time with their loved ones and working closely with the entire care team.

“Families are instrumental in helping us, the providers and caregivers, understand when there are changes in their family members,” said Jeanne Kessler, RN, GRN. “We can’t just assume that an elderly person who is confused in the hospital is always confused—we need to listen to family members so they can tell us if their behavior is different for that person. They know the patients better than we do. They have to be involved and we have to listen.”

 

Is delirium the same thing as dementia?

Delirium is different from dementia. Delirium comes on  quickly, fluctuates and usually lasts for a shorter time. Dementia develops more slowly and can’t be reversed.

Despite their differences, delirium and dementia are related.

“If you have dementia, your risk for delirium is much higher because you already have impaired thought processes that can be easily stressed,” said Waszynski. “New research also shows if you have a history of delirium, even if you have recovered from it, your risk for dementia later in life is higher. So we know there is a relationship and more studies will help us understand the associations even better.”

Did you know?

  • 1 in 4 older hospital patients will experience delirium
  • $150 billion is spent each year taking care of delirious patients
  • 5x death rate among patients with delirium
  • 5x longer hospital stays compared to patients with the same conditions

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