This week’s Q & A call was about how to better manage health and healthcare issues, when you’re taking care of someone with a dementia such as Alzheimer’s.
Most of the caregivers’ questions were about delirium. This is the state of worse-than-usual confusion that people can develop when they are sick or under serious stress.
I love talking to Alzheimer’s caregivers about delirium, because this is a really common problem that family caregivers absolutely can do something about!
The key is to know that people with dementia are especially prone to get delirium when they fall ill (especially in the hospital). And then you’ll want to know the basics on how to spot this problem, and how to get the doctors to address it properly.
A fact I wish more caregivers of elders knew: delirium can be the only obvious sign of a potentially serious health problem, such as a heart attack, a urinary tract infection, or a pneumonia. (Especially when it comes to older people with Alzheimer’s, they often don’t voice focused complaints the way younger people do.)
The trouble is, even though delirium is very common in older adults, studies have shown that it’s often missed by doctors and nurses. This is a important problem in healthcare, for three key reasons:
- Delirium is a sign of something being wrong with the body, or the person. Whether it’s a life-threatening infection or just too much sleep-deprivation in the hospital, it’s important to identify and reverse the delirium triggers as quickly as possible.
- People are at risk for injury while delirious. People who are delirious are more likely to fall. They are often restrained in the hospital to keep them from pulling out IVs (although being tied up can cause greater stress and worsen the delirium). Delirium has been linked to longer hospital stays, and worse healthcare outcomes.
- Delirium can cause permanent declines in mental abilities. As I explain in this post, titled “A common problem that speeds Alzheimer’s decline,” studies have found that after delirium, some people never recover all the way back to their previous abilities. Research has also suggested that delirium episodes can speed up cognitive decline overall.
I really believe it’s important to think beyond eating blueberries to slow down brain decline. In my mind, preventing delirium and promptly trying to treat it are actually more likely to protect an older person from harm.
How you can learn to prevent, recognize, and treat delirium
Preventing delirium: Now, it’s not possible to prevent all cases of delirium. But there are things that YOU can do, to reduce the chance of a bad delirium. Try this resource:
- “For Older Adults & Caregivers“, from the Hospital Elder Life Program
Recognizing delirium: To learn to spot delirium in someone with a dementia such as Alzheimers, try these:
What to do about delirium: For more on what to do if you suspect delirum, and to make sure your loved one gets the right work-up:
- FAQ: What Should I Do if I Think My Loved One Is Having Delirium in the Hospital?
- What Doctors Should Evaluate When Someone With Dementia Becomes Delirious
What to expect after delirium: Even when all the right things are done — including getting the person home to a restful familiar environment — it often still takes a while for delirium to get better. In fact, it’s pretty common for it to take weeks, or even months, for delirium to completely resolve in an older adult. (I once had a 90 year-old patient slowly get better over a whole year!) For more info:
If your loved one has had delirium in the past, the most important thing to know is that he or she will be at high risk of developing it in the future. So, be sure to review the resources above on preventing delirium, and on spotting it quickly if it comes up.
You can also visit Caring.com’s Dementia and Delirium Solution Center, which I helped create back in 2011. I hope this information will help you feel more prepared and informed as a family caregiver.
Have you had any experiences with delirium? Please share any stories or questions below in the comments!
Hi. Thank you so much for this blog. My dad is currently in a senior psych unit and experiencing extreme delirium (which I figured out thanks to your blog). He went there to try to get medication for the delusions and hallucinations he’s been experiencing the past 5 months (seemingly due to dementia, but he didn’t get that diagnosis) but he’s had a SHARP decline and now can hardly speak and definitely can’t take care of himself.
My question is, what do we do now? This psych unit does not seem to be taking good care of him, and certainly isn’t a calming environment. My step mom understandably doesn’t feel like she can care for him at home anymore. But the psych unit says he’s not stable enough to transfer to memory care. We feel so stuck. Do you have any recommendations? Thank you.
Nicole Didyk, MD says
I’m sorry your family is going through this. Some mental health conditions in older adults (due to dementia, delirium, or some other cause) are so severe and difficult to live with that the person needs admission to a specialized unit like the one you’re describing. Even in that setting, it can seem like progress is slow or moving in the wrong direction.
If your father is having symptoms that are too serious for him to manage at his memory care home, then the psychiatric facility is probably the best place for him to get the treatment he needs.
If you feel that his care isn’t appropriate, maybe you can get another opinion from a psychiatrist to learn if there’s a better program for him or medication changes that might help.
Thank you for your reply
My Dad is 94 living in aged care with some dementia.
He has just spent 17 days in room isolation due to covid and has now gone into a delirium.
Prior to his isolation and covid he was able to self care and hold a conversation. Now he is so disoriented he can’t even find the bathroom in his room and his verbal ability consists of very good and thank you. He has become unco operative and occasionally mildly aggressive.
After 4 days out of isolation he is back in isolation due to another case at his care facility.
I am very anxious for him and feel quite powerless. Whilst facility is very good I feel they aren’t recognising his delirium just happy he finally had a negative covid test.
Nicole Didyk, MD says
Thanks for sharing your family’s heartbreaking story, one that’s similar to many I’ve heard throughout the pandemic.
Delirium can take days to months to resolve, and it can cause a person to lose ground and independence. It is good that he’s in his home, with familiar people and objects, which can speed his recovery. I can understand feeling powerless, and it might help to ask the home what you can do to provide some social interaction and stimulation for your dad. Maybe increasing the amount of electronic contact, or providing more comforting and familiar objects or music will help.
I watched my father in law pass away from dementia. Now my aunt has dementia and delirium from a broken hip surgery. I think my aunt is in beginning stage of 7. She has to wear diapers and is very confused. Nothing she says makes any sense but I just agree with her. She is refusing to eat and refusing medication. My sister and father want me to talk to my aunt to encourage her to eat and take medication. I feel that on some level she wants to pass away and feel it should be her right. The life she is living now is horrible with only worse to come. I can hardly blame her if she wants to move on. Is it wrong of me to think like this?
Nicole Didyk, MD says
I’m sorry to hear about your aunt’s dementia, and it does sound like she’s in an advanced stage. Feeding problems are very common in advanced or end-stage dementia and it’s hard to increase the person’s intake without artificial intervention, which we almost always discourage.
Feeding tubes and intravenous fluids can cause harm and be very uncomfortable, and they rarely produce the desired solution long-term.
It’s not clear that verbal encouragement will work so you may just cause stress by trying to talk your aunt into eating. In fact, a recent review of environmental and behavioral interventions to improve intake in people with dementia didn’t find enough evidence to recommend any particular treatment.
I’m with you on taking your cues from your aunt about what’s important to her right now, and if food isn’t it, then don’t push it. Seeking to minimize her suffering and providing comfort is probably the best approach right now.
When I click on the links to learn more about Delerium, most of the pages have been deleted.
Can you please update this page so it redirects correctly?
Nicole Didyk, MD says
Thanks so much for letting us know about the broken links. Unfortunately, some of the articles are temporarily unavailable and we will link to them as soon as we can. I hope resources that are linked to are helpful!
My father in law was diagnosed with dementia 3 years ago. Overall, he was functioning relatively well in the stable home environment and routine established by his wife. Last month, a medical emergency involving their daughter in another province prompted them to fly there and help her through her recovery. My mother in law did have valid concerns about how the disruption of his routine might adversely affect my father in law, but ultimately felt they had no choice but to go. He did okay the first few weeks – some occasional confusion about where he was or who people were – but generally returned to present circumstance with explanations from his wife and daughter. But the past 3 days his mental state took a rapid turn for the worst – he is having anxiety attacks, confusion, and does not know who his family are. He keeps shouting that he wants to go home. My mother in law has booked them the first available flight back this coming Saturday, but she is worried that this setback might have permanent consequences on his mental state. She is hoping a return to home and routine will soothe him and he will return to baseline. I fervently hope this is the case. Thank you for sharing your informative and warm articles with all of the caregivers who struggle daily and second guess their choices. We can only reach out and try to find some way forward.
Nicole Didyk, MD says
I’m so sorry about to hear about the difficulty that your father in law has been having, and I hope that their daughter recovers soon. The symptoms you describe suggest that it’s likely that there is an element of delirium, as you describe that there are sudden changes marked by confusion and some disorganized thinking, And maybe even some fluctuation.
When there’s a delirium in the setting of dementia we do advise that somebody get back into a normal routine as soon as possible. In 80% of cases delirium does recover completely but some people do seem to be at a baseline that’s different than where they started.
All of the strategies that we suggest to prevent delirium can be implemented when a delirium takes hold as I’m they are likely to do some good. This would include encouraging physical activity and socialization with others as much as possible and avoiding medications that can be overly sedating or have anticholinergic properties.
I’m glad you’re finding the articles on the website helpful and I would encourage your mother in law, if she has time to review some of the information on the site and also at my website, which has lots of Canadian-based content. Most of all tell your mother in law not to feel guilty about how things have turned out. Many people are pulled in different directions and everything is so much harder now with COVID. I wish you and your family the best.