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Ageing
Hospital Delirium Can Be Fatal For The Elderly
Date: 07/11/11
Many of us have our own hilarious stories about waking up
dazed or confused when we're away from home. However, when
it happens in the hospital, it's not so funny. In fact, it
can be terrifying! As one hospital administrator said, "A
delirious patient happens almost every day." And he
describes their experience as "sheer terror, like their
worst nightmare."
Hospital delirium is most likely to affect patients who have had surgery, especially those in intensive care (ICU). It occurs most frequently in older patients. In fact, about one out of three patients over the age of 70 will develop hallucinations that seem horrifyingly real.
Even worse is the fact that this cruel condition is darkened by the shadow of dementia. Studies have shown that patients who already have dementia are at higher risk of hospital delirium. Healthy patients who lapse into temporary delirium are at higher risk of developing dementia later in life.
Sadly, the outlook is even worse for the elderly. A quarter of elderly patients who experience hospital delirium are placed in assisted care, and one out of ten dies within a month.
Recognising the signs
It's important for family and hospital care-givers to know that they can help reduce delirium risk. The first step is to watch for factors that increase the risk. This includes anything that can disrupt normal brain function, including inflammation, infection, and substances that interfere with brain chemicals (neurotransmitters). That's why many medications can trigger delirium, including narcotic painkillers, antidepressants, sedatives, antihistamines, and certain drugs used to treat high blood pressure, incontinence, nausea and allergies.
Recently, a Johns Hopkins University study, in the US, showed that rates of delirium can be cut in half just by using lighter sedation in patients who have hip fracture surgery.
But even with no drug use, hospital delirium can be triggered by disorientation caused by disruption of daily routines, isolation from immediate family and pets, a strange room, room changes, constant night-time activity, interrupted sleep, and undergoing repeated medical tests.
The good news is that 40 per cent of delirium cases are preventable and family have an important role to play, because hospital personnel are not always on the lookout for delirium. In fact, doctors and nurses who are unfamiliar with a patient are less likely to spot abnormal behaviour.
Giving a helping hand
Dr. Edward Marcantonio, associate professor of medicine at Harvard Medical School, said: "An engaged and attentive family member can help prevent delirium and advocate for the patient so they receive optimal care."
Since, family members are often the only ones who see a loved one through the entire journey from primary care to hospitalization to rehabilitation, the first thing they can do to help is to look out for the symptoms of hospital delirium, these include: confusion and poor concentration, suspicious, anxious, or fearful behaviour, slurred speech, patient doesn't recognize family members and distorted visual perceptions.
There are also a few other things family members can do to help prevent or limit the chances of delirium:
Sources:
'When Patients Suddenly Become Confused' published online, health.harvard.edu
'Hospital delirium is common and often goes unrecognized, reports Harvard Women's Health Watch' published online, health.harvard.edu
"Delirium in hospital can be a killer for the elderly" Peter Aldhous, New Scientist, 7/27/11, newscientist.com
"Hallucinations in Hospital Pose Risk to Elderly" Pam Belluck, New York Times, 6/20/10, nytimes.com
"Detecting Hospital Delirium" Johns Hopkins Health Alerts, 6/16/08, johnshopkinshealthalerts.com
"Eskimo Study Suggests Diet rich in Omega-3 Fats May Reduce Risk of Obesity-Related Disease" Newswire, 3/24/11, newswire.com
Back to topHospital delirium is most likely to affect patients who have had surgery, especially those in intensive care (ICU). It occurs most frequently in older patients. In fact, about one out of three patients over the age of 70 will develop hallucinations that seem horrifyingly real.
Even worse is the fact that this cruel condition is darkened by the shadow of dementia. Studies have shown that patients who already have dementia are at higher risk of hospital delirium. Healthy patients who lapse into temporary delirium are at higher risk of developing dementia later in life.
Sadly, the outlook is even worse for the elderly. A quarter of elderly patients who experience hospital delirium are placed in assisted care, and one out of ten dies within a month.
Recognising the signs
It's important for family and hospital care-givers to know that they can help reduce delirium risk. The first step is to watch for factors that increase the risk. This includes anything that can disrupt normal brain function, including inflammation, infection, and substances that interfere with brain chemicals (neurotransmitters). That's why many medications can trigger delirium, including narcotic painkillers, antidepressants, sedatives, antihistamines, and certain drugs used to treat high blood pressure, incontinence, nausea and allergies.
Recently, a Johns Hopkins University study, in the US, showed that rates of delirium can be cut in half just by using lighter sedation in patients who have hip fracture surgery.
But even with no drug use, hospital delirium can be triggered by disorientation caused by disruption of daily routines, isolation from immediate family and pets, a strange room, room changes, constant night-time activity, interrupted sleep, and undergoing repeated medical tests.
The good news is that 40 per cent of delirium cases are preventable and family have an important role to play, because hospital personnel are not always on the lookout for delirium. In fact, doctors and nurses who are unfamiliar with a patient are less likely to spot abnormal behaviour.
Giving a helping hand
Dr. Edward Marcantonio, associate professor of medicine at Harvard Medical School, said: "An engaged and attentive family member can help prevent delirium and advocate for the patient so they receive optimal care."
Since, family members are often the only ones who see a loved one through the entire journey from primary care to hospitalization to rehabilitation, the first thing they can do to help is to look out for the symptoms of hospital delirium, these include: confusion and poor concentration, suspicious, anxious, or fearful behaviour, slurred speech, patient doesn't recognize family members and distorted visual perceptions.
There are also a few other things family members can do to help prevent or limit the chances of delirium:
-
Consult with a geriatric specialist: Not all doctors
and surgeons are familiar with delirium. When an
elderly person is considering surgery or any
procedure requiring anaesthesia or sedation, advice
from a geriatrician can help with medication, pain
control, post-operative mobility, and sleep support.
Bring a list of medication: As mentioned before, there are many drugs that can cause delirium. That's why an elderly person may risk delirium even if he or she is taking each drug at the recommended dose. All medications should be reported even if they haven't caused problems in the past, because they might interact with drugs given in the hospital.
Keep it familiar: Take a few family photos or familiar objects (such as a blanket, or favourite relaxation or soothing music) to the hospital, to make it feel more like home. Calm conversations about current events or family activities can be reassuring.
Stay close: Having family members around regularly provides comfort, familiarity, and reassurance. If possible, have someone there night and day while the patient is in a state of delirium.
Keep it real: Reading glasses, hearing aids, and dentures are often put away during a hospital stay, but that can leave the patient disoriented and less able to function. Make sure that they have everything that will make them feel like their normal selves.
Stay active: If possible, help your loved one get up and take them for a walk two or three times a day. If you can, talk to them in simple language or help them exercise their brains with conversation, crosswords or card games.
Be there for meals: Any one knows that there is nothing as depressing as having a meal on your own. Even more so in a hospital. Your companionship and assistance will help your loved one eat and drink an adequate amount, and also enjoy the experience.
Participate in discharge planning: Patients are sometimes sent home or to a nursing or rehabilitation facility while they are still delirious. A patient with delirium can't fully understand discharge instructions, so you'll need to help.
If transferred to another facility, make sure the nursing staff there understands your loved one's needs so they won't assume that his or her current behaviour is typical. Ask for a complete medication review. It might help to discontinue some drugs (such as sedatives) that were added during hospitalization.
Sources:
'When Patients Suddenly Become Confused' published online, health.harvard.edu
'Hospital delirium is common and often goes unrecognized, reports Harvard Women's Health Watch' published online, health.harvard.edu
"Delirium in hospital can be a killer for the elderly" Peter Aldhous, New Scientist, 7/27/11, newscientist.com
"Hallucinations in Hospital Pose Risk to Elderly" Pam Belluck, New York Times, 6/20/10, nytimes.com
"Detecting Hospital Delirium" Johns Hopkins Health Alerts, 6/16/08, johnshopkinshealthalerts.com
"Eskimo Study Suggests Diet rich in Omega-3 Fats May Reduce Risk of Obesity-Related Disease" Newswire, 3/24/11, newswire.com
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