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Better Health While Aging

Practical information for aging health & family caregivers

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The Geriatrics For Caregivers Blog

Learn practical ways to improve the health and wellbeing of older adults!

Written especially for family caregivers of older adults, but useful for all who want to learn how geriatricians help aging adults.

How to Promote Physical Health While Aging:
The Healthy Aging Checklist Part 2

by Leslie Kernisan, MD MPH

Old man shooting a basketball ball and looking to sky in the park

This is the second in a series of posts explaining my Healthy Aging Checklist.

Remember, for the healthiest aging, we need to do the things that optimize health — and health care — so that the brain and body work at their best for now, and for the future.

I’ve identified six broad actions to take:

The Healthy Aging Checklist:

  • Promote brain health and emotional well-being.
  • Promote physical health.
  • Check for and address common aging health problems (e.g. falls, pain, memory problems, depression, isolation, incontinence, polypharmacy, etc).
  • Learn to optimize the management of any chronic conditions.
  • Get recommended preventive health services for older adults.
  • Address medical, legal, and financial advance care planning.

In this post, we’ll cover proven ways to promote and maintain physical health as one ages.

6 Proven Ways to Promote Physical Health

Here are the six “healthy living” actions that I recommend, for promoting physical health in all older adults. They all have a solid track record (which cannot be said for everything I see recommended online). They are also good “bang-for-the-buck,” in part because they provide real benefits to just about everyone who adopts them. And they help whether or not an older person has already developed chronic illnesses.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: healthy aging

How to Promote Brain Health:
The Healthy Aging Checklist, Part 1

by Leslie Kernisan, MD MPH

Aging brain

“Doctor, what do you recommend for healthy aging?”

“My mom is getting older and I want to help her stay healthy. What should we be doing?”

On this site, I usually write about how to manage or avoid specific aging health challenges. But in real life, I often get asked the questions above. After all, many people want advice on how to be healthier, or stay healthy.

That’s because we all intuitively know that maintaining good health (including cognitive function) is key to maintaining what is most important to us as we age: our ability to be physically and mentally capable, so that we can remain active, engaged in our lives, and as independent as possible.

We also know that poor health can bring on pain and other symptoms, as well as disabilities that can jeopardize how we live our usual lives. In fact, most “aging” problems that older adtuls and families struggle with — like difficulties with mobility, memory, or independence —  track back to underlying health problems.

So it’s good to know how to maintain one’s health as one ages, in order to keep our minds and bodies working well for as long as possible.

Furthermore, healthy aging isn’t just about forestalling aging or disability. It’s also about knowing how to make the best of things even once you do have chronic diseases or chronic disabilities of the mind or body. I call this optimizing health, for better health while aging.

It means optimizing one’s health — and health care — so that the brain and body work at their best for now and for the future. And the beauty of this is that the same key things work, whether you are a “healthy” older person with no particular health problems versus someone who has chronic conditions or even an “uncurable” disabling disease such as Alzheimer’s.

In this series of posts, I’m going to tell you how to do this.

The Healthy Aging Checklist

For the healthiest aging, do this:

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: brain health, healthy aging, memory

6 Causes of Paranoia in Aging & What to Do

by Leslie Kernisan, MD MPH

paranoid elderly mother

Q: My mother is 80.  She is very active (despite breaking her hip 2 years ago), she still attends water therapy 3 times a week at the YMCA, she drives to the base (which is 20 miles away) and pays her bills on time.  She is a retired Psych nurse and has shown signs in the past of paranoia. 

Lately, she has “heard” voices of her grandchildren in her home and called my sister. She also has difficulty with getting the right words to say out and has her sleep pattern out of whack and will call people at odd times of the night.  With her independence comes the fact she won’t share any medical information because she thinks we are out to get her committed.  

How can I test her/question her to find out the level of decline she may be in to make sure she is safe? — K

A: Great question. As you may know, it’s fairly common for aging adults to develop problems like the ones you are describing. Some older adults will also start leveling a lot of false accusations. Understandably, these problems are frustrating and worrying for adult children.

You are absolutely right to be concerned about your mom’s safety. I do have some ideas for how you can get started assessing her, which I share below.

But first I want to explain the most common causes of this type of behavior in older adults. That’s because one of the things you must do is help your mother and the doctors figure out why she’s developed these behavior changes and other symptoms.

A fair number of people don’t get around to the medical evaluation because they assume that these crazy behaviors are either normal aging (definitely false) or dementia such as Alzheimer’s (true about 40% of the time).

Furthermore, it’s often hard to get a resistant older parent medically evaluated.

Still, it’s worth persisting in this, because many causes of paranoia or other odd behavior in older people can be treated.

Paranoia, false accusations and psychosis

Paranoid symptoms (e.g. believing that someone is out to get you, or is taking your stuff, or is in the house at night) falls into a category of mental symptoms that is technically called “psychosis.”

Symptoms of psychosis can include:

  • Delusions, which means believing things that aren’t true or real (which can include false accusations)
  • Hallucinations, which means seeing or hearing things that aren’t there.
  • Disorganized thoughts or speech, meaning saying or thinking things that seem illogical or bizarre to others.

Psychosis is uncommon in younger people but becomes much more common as people get older. That’s because any of these symptoms can emerge when people’s brains aren’t working properly for some reason.

A 2015 review article on “late-life psychosis” estimates that 23% of people will develop symptoms of psychosis in late life.

6 causes of paranoia and psychosis in aging

In the above review article, the authors organize the causes of late-life psychosis into six “Ds”:

  • Delirium (10 %).
    • This is a very common condition of “worse-than-usual” mental function, often brought on by the stress of severe illness, surgery, or hospitalization. See 10 Things to Know About Delirium for more.
  • Drugs, alcohol, and other toxins (11%)
    • Medication side-effects can cause delusions, hallucinations, or other forms of psychosis. Pay special attention to medications known to affect memory and thinking. Abuse of — or withdrawal from — alcohol or other substances can also cause psychosis symptoms.
  • Disease (10%)
    • Many physical health problems can interfere with brain function. These include electrolyte problems such as abnormal levels of sodium, potassium, calcium, or magnesium in the blood, low levels of vitamin B12 or folate, thyroid problems, severe liver or kidney dysfunction, infections, and neurological diseases. Brain damage from minor strokes can also cause psychosis symptoms.
    • Urinary tract infections can cause psychosis, but in my experience, they are almost never the cause of paranoia or other symptoms that have been going on for weeks, months, or longer. (A positive urine culture in an older person who has been having psychosis symptoms for a while probably reflects a colonized bladder.)
  • Depression (33%) and other “mood disorders,” including bipolar disease (5%)
    • About 15% of people with major depression may experience psychotic symptoms. Delusions of guilt or deserved punishment are especially common.
  • Dementia (40%), including Alzheimer’s disease, Lewy-Body dementia, and others
    • Delusions are extremely common in dementia, especially delusions of theft, spousal infidelity, abandonment, and persecution. Hallucinations (especially visual hallucinations) are also common, especially in Lewy-Body dementia. For more on how dementia is diagnosed, see How We Diagnose Dementia: The Practical Basics to Know.
  • Delusional disorder (2%) and schizophrenia-spectrum disorders (1%)
    • These two conditions have many symptoms that overlap with those of dementia, delirium, or other conditions affecting thinking. Doctors must exclude these more common conditions before diagnosing a person with schizophrenia or delusional disorder. Schizophrenia affects an estimated 0.1-0.5% of people over age 65. Many were diagnosed earlier in life but some people can develop the condition later in life. Delusional disorder affects an estimated 0.03% of older adults.

The authors of this review article also note that it’s common for older adults to have vision and hearing problems, both of which can trigger or worsen delusions and hallucinations.

So as you can see, when older adults experience delusions, hallucinations, and paranoid thoughts, there is almost always something more going on with their health. Figuring out what is beneath the “crazy” or “irrational” or “paranoid” behavior is key.

Hence, I recommend you keep these six causes of paranoid symptoms in mind, as you try to find out more about how your mom has been doing.

I also recommend you check for other signs of problems with thinking or memory; you can learn about 21 signs I recommend checking for in the video below.

 

How to check on “levels of decline” and safety

It’s great for you to be proactive and want to help check on your mother safety and situation. Ultimately you’ll need to work with professionals, but you can speed the process along by checking for common red flags, and bringing them to the attention of your mother’s doctor.

As a geriatrician, I generally try to assess an older person in the following five domains:

  • Ability to manage key life tasks
    • These include the ability to manage Activities of Daily Living (key tasks we usually learn as young children, such as walking, dressing, feeding ourselves, and toileting) and also Instrumental Activities of Daily Living (key tasks we learn as teenagers, such as managing finances, transportation, meal preparation, home maintenance, etc).
  • Safety red flags
    • This includes signs of financial vulnerability or exploitation, risky driving, leaving the stove on, wandering, or signs of elder abuse.
  • Physical health red flags
    • These include weight loss, declines in strength or physical abilities, falls, frequent ER visits, and complaints of pain.
  • Mood and brain health red flags
    • These include common signs of depression (especially sadness and/or loss of interest in activities), signs of loneliness or isolation, new or excessive worrying, as well as other signs of memory and thinking problems
  • Medication management red flags
    • These include signs of difficulty taking prescriptions as directed, checking on possible medication side-effects, and identifying medications that are on the Beer’s list of medications that older people should avoid or use with caution.

Because concerned family members often ask me about checking on an older parent, I’ve written a book, “When Your Aging Parent Needs Help,” that walks families through how to do this; it includes checklists based on the five sections above.

You can use the book and checklists to spot these red flags that often represent serious safety or health problems.

Now, no book is going to enable you to diagnose your parent. And no book can guarantee that you’ve identified and addressed the most important safety issues. You’ll need to work in person with professionals to do that.

But by being methodical in observing your mom and in documenting your observations, you will make it much easier for professionals to figure out why your mother has developed these behaviors you are concerned about.

Also, by identifying specific red flags or problem areas, you’ll be better equipped to work with your mom and other family members on addressing safety concerns. That’s because it’s much more effective to focus on issues that are specific and concrete (“I noticed that you seem to be having trouble with your grocery shopping”), rather than simply telling an aging parent that you are worried about their safety.

Tips on following up on safety issues and memory problems

Once you’ve identified safety issues and signs of underlying health problems, you’ll want to follow up. You’ll need health professionals to help evaluate and manage any underlying health problems, and you may find you need help from other types of experts as well.

If your older parent is paranoid and resisting your involvement, this often becomes a stuck spot for families.

How to get unstuck depends on the situation. Here are some ideas that often help:

  • Relay your concerns to your parent’s doctor. The doctor needs to know about the symptoms and problems. The doctor may also be able to persuade your older parent to accept some help, or even the presence of another family member during medical visits.
    • Patient privacy laws (e.g. HIPAA) do not prevent families from providing information to a person’s doctor over that person’s objections.
    • The doctor will probably not disclose health information to you but may do so under certain circumstances. That’s because when a patient is “incapacitated”, doctors are allowed to disclose relevant health information to family members, if they feel it’s in the best interest of the patient. For more on when health providers may disclose information to family members, see 10 Things to Know About HIPAA & Access to a Relative’s Health Information.
    • If you send your concerns in writing, they will probably be scanned into the medical record.
    • Also ask if any social work services are available through your parent’s health provider.
  • Contact organizations that support older adults and families, for assistance and for referrals. Some good ones to try include:
    • Your local Area Agency on Aging; find it using the locator here.
    • Family Caregiver Alliance. The navigator showing state-by-state services is especially nice.
    • Local non-profits serving seniors and families. Try using Google to find these.
  • Get help from a geriatric care manager (now known as aging life care professionals) or other “senior problems” expert. This usually requires paying out-of-pocket, but can enable more hands-on assistance than is usually available through social workers and non-profits.
    • The ideal person will be good at difficult conversations with older adults, will be able to help you communicate with doctors if necessary, and will know what local resources are available to address any safety or living issues you detect.
  • Get advice from other adult children who have faced similar situations. You can find caregiving forums and message boards online, where people share ideas on getting through these challenges.
    • There’s an active forum of people caring for older relatives at AgingCare.com.  You can find a lot of ideas and support there. However, most such forums have minimal moderation from professionals, so you should double-check on any medical, legal, or financial advice you get.
    • Daughterhood.org is a website and community for people helping older parents. Look to see if they have a local “Circle” near you.
  • Consider contacting Adult Protective Services if you think this might qualify as self-neglect. Self-neglect means an older person is living in a way that puts his or her health, safety, or well-being at risk. It’s not uncommon for older adults with memory or thinking problems to self-neglect.
    • This is considered a form of elder abuse and can be reported to Adult Protective Services (APS).
    • For a good overview of self-neglect and how APS can get involved, see here.
    • In most states, health providers and certain other professionals are “mandated reporters” for elder abuse and self-neglect, which means they are supposed to report any such suspected cases to APS.

When it comes to contacting the doctor and hiring an expert to help, it’s best if you can get your mom’s agreement before proceeding. (Or at least, not have her explicitly forbid you from doing these things). Here are some tips to help with your conversations:

  • Use “I” statements as much as possible. “I’ve noticed you’ve been calling people during the night. I’ve noticed you sometimes have difficulty with your words. I’m concerned and I’ve heard it’s important to have such symptoms evaluated by a doctor, because they can be due to treatable medical problems.”
  • Frame any suggestions you make as a way to help your mother achieve her goals. For most older adults, these include living at home for as long as possible, maintaining good brain function and physical function, and otherwise remaining as independent as possible.
  • Avoid relying on logic. Logic never works well when it comes to emotionally-charged subjects. And it especially doesn’t work if people are experiencing any difficulties with memory or thinking. So don’t expect your mom to be logical and don’t rely on logical arguments to convince her.

For more on approaching a parent who is resistant to help, I explain how to do this in my free online training for families:

Now, if you find it causes your mother intense anxiety or agitation to discuss your concerns and your suggestions for helping her, it may be reasonable to just proceed. After all, you do have reasons to believe that some kind of health issue is affecting her thinking.

So especially if you’ve identified any safety problems, it’s reasonable to move ahead despite her preference that you not intervene.

In closing, I’ll reiterate that this is a very tough situation to navigate, and it usually takes time and persistence for families to make headway. Do try to take care of yourself as you work through this. Connecting with others facing similar challenges is a great way to get support and practical ideas on what to do next.

Good luck!

This article was last reviewed and updates were made in March 2025.

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles, Managing relationships, Q&A Tagged With: memory, paranoia, resisting help

6 Common Medication Problems in Aging, & What You Can Do

by Leslie Kernisan, MD MPH

Too many pills?If you’re helping an older person with health and healthcare, chances are that person is taking at least a few prescription medications, if not several.

Do you ever wonder if he or she is on the right medications? Do you worry about side-effects and interactions?

These are sensible concerns to have. Many older adults end up experiencing “polypharmacy,” which means taking more than 5 medications concurrently.

And although medications do often help maintain health and wellbeing, studies have repeatedly shown that lots of older adults end up suffering from problems related to medication.

Polypharmacy, predictably, increases the risk of problems.  (Polypharmacy is usually defined as taking five or more medications concurrently.) But even older adults taking one to three daily medications can encounter problems.

So I want to share a list of common ways that medications affect the health and wellbeing of aging adults. I’ll then explain what you can do, to minimize these problems.

Six Common Medication-Related Problems in Aging Adults

Here are the most common problems that I see: [Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: medication safety, medications

5 Types of Medication Used to Treat Sundowning & Difficult Dementia Behaviors

by Leslie Kernisan, MD MPH

medication for Alzheimer's behavior

One of the greatest challenges, when it comes to Alzheimer’s disease and other dementias, is coping with sundowning and with difficult behaviors. 

These are symptoms beyond the chronic memory/thinking problems that are the hallmark of dementia. They include problems like:

  • Delusions, false accusations, paranoid behaviors, or irrational beliefs
  • Agitation (getting “amped up” or “revved up”) and/or aggressive behavior
  • Restless pacing or wandering
  • Disinhibited behaviors, which means saying or doing socially inappropriate things
  • Sleep disturbances

These are technically called “neuropsychiatric” symptoms, but regular people might refer to them as “acting crazy” symptoms. Or even “crazy-making” symptoms, as they do tend to drive family caregivers a bit nuts.

And when these behaviors happen in the late afternoon or early evening, it’s usually called “sundowning“. (In most cases, sundowning is triggered by fatigue; anticholinergic medications may cause sundowning symptoms as well.)

Because these behaviors are difficult and stressful for caregivers — and often for the person with dementia — people often ask if any medications can help.

The short answer is “Maybe.”

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: alzheimer's, dementia, medication, paranoia

How to find geriatric care — or a medication review — near you

by Leslie Kernisan, MD MPH

Medications & Aging

A caregiving daughter once wrote in and asked me this common question:

“How can I find a gerontologist* near me to review medications, and help care for my mother with dementia?”

As you may have noticed if you’re a regular reader, I often emphasize the importance of spotting and reducing risky medications, especially those associated with falls or memory problems.

Understandably, this caregiver wants to find a geriatrician who can review her mother’s medications, and otherwise oversee her mother’s care.

(*Note: Technically, a geriatrician and a gerontologist are not the same. Gerontology is the social science discipline of all things aging, and one can get either a master’s or a doctorate in this field. Whereas geriatrics is a medical specialty, so geriatricians must first get a medical degree, then do a residency in internal medicine or family medicine, and then do specialty training. So when people say they want a gerontologist for medical care, what they really want is a geriatrician.)

Now, medication review is usually included in geriatrics primary care. Geriatric care, after all, means healthcare modified to be a better fit with what happens as people get older. And being careful with medications is pretty integral to this approach.

But, although geriatric primary care is certainly worth looking for, it can be hard to find. (Read on for suggestions below.)

So it’s good to have a plan B, which can be getting a medication review — and fall risk assessment — outside of geriatric primary care. This can also be a good option if an older person is reluctant to change primary care doctors.

In this article, I’ll describe 3 places to look for geriatric primary care, and then 3 options for medication review.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles, Q&A Tagged With: medication safety

How Sex Changes With Aging (& What You Can Do About It)

by Nicole Didyk, MD

(This article is a special guest post by geriatrician Dr. Nicole Didyk, founder of the blog and YouTube channel The Wrinkle. Like me, Dr. Didyk has a particular interest in informing and empowering older adults and families. So I’ve been very glad to have her contributing to the site, and I appreciate her covering some topics that I haven’t  had the time to address. Enjoy! — L. Kernisan)

Quick! Think about older adults and sex. What comes to mind? George Burns cracking wise about sex after 90 being like trying to shoot pool with a rope? A sweet old couple holding hands in their rocking chairs? Nothing?

The truth is that what pops into people’s minds, when it comes to older adults and sexuality, is often negative. For instance, it’s common for older adults to be thought of as:

  • “Cute” in a chaste and childlike way,
  • Predatory and/or “lecherous”, as in the “cougar” or the “dirty old man”, or
  • Problematic (think sexual behavior when someone has dementia, or sex between nursing home residents).

This, of course, is largely due to pervasive ageism in society. Sexuality, sexual expression, and the urge for physical intimacy is actually an important part of every adult person’s life.

So it’s sad that it’s so common for it to be treated as “inappropriate” or otherwise discouraged in later life. But fortunately, we’re starting to see significant progress in combatting this aspect of ageism, too.

In my job as a consultant Geriatrician, I see older adults about a wide range of issues, including memory changes, falls, pain, depression, and medication adjustment.  But what is often affected by all of those medical issues – yet rarely talked about — is sex.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog

3 Ways to Prevent Injury From a Fall
(Plus 3 Ways That Don’t Work as Well as You’d Think)

by Leslie Kernisan, MD MPH

elderly person falling hip fracture

Worried about falls in an older person?

You’re right to be concerned, especially if the older person has already experienced a fall. Research suggests that falling once doubles your chance of falling again.

And falls, as everyone knows, can cause life-changing injuries. The Centers for Disease Control (CDC) reports that:

  • One out of five falls causes a serious injury such as broken bones or a head injury
  • Each year at least 300,000 older people are hospitalized for hip fractures
  • More than 95% of hip fractures are caused by falling, usually by falling sideways
  • Falls are the most common cause of traumatic brain injuries

For these reasons and more, preventing falls is a major focus of preventive care for older adults, and is a big part of what we do in geriatrics. (Learn more about how we do this in this article: Why Older People Fall & How to Reduce Fall Risk.)

But if we want to protect older people from the potentially devastating consequences of falls, it’s not enough to help them reduce falls.

We also need to think about how we can reduce the likelihood of injury from a fall.

In this article, I’ll share with you three approaches that can help reduce fall-related injuries.

Then I’ll address two other approaches that are sometimes tried, but are less likely to help.

3 ways to prevent fractures and other injuries related to falls 

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles

What the Blood Pressure Guidelines — & Research — Mean For Older Adults

by Leslie Kernisan, MD MPH

blood pressure monitor and medications

Are you on medication to lower blood pressure? Or are you caring for an older person with hypertension, also known as high blood pressure? 

If so, you are probably wondering just what is the right blood pressure (BP) for older adults.

This is a good question, given that guidelines on blood pressure have changed, especially due to the results of the landmark Systolic Blood Pressure Intervention Trial (abbreviated as “SPRINT”).

The SPRINT study first made headlines in part because the findings seemed to contradict expert hypertension guidelines released in December 2013, which for the first time had proposed a higher goal BP ( a systolic BP of less than 150mm mercury) for most adults aged 60 or older.

In particular, SPRINT randomly assigned participants — all of whom were aged 50 or older, and were at high risk for cardiovascular events — to have their systolic blood pressure (that’s the top number) treated to a goal of either 140, or 120. Because the study found that people randomized to a goal of 120 were experiencing better health outcomes, the study was ended early.

For those of us who specialize in optimizing the health of older adults, this was obviously an important research development that could change our medical recommendations for certain older adults.

But what about for you, or for your older relative? Do the SPRINT results mean you should talk to the doctor about changing your BP medications?

Maybe yes, but quite possibly no. In this article, I’ll help you better understand the SPRINT study and results, as well as the side-effects and special considerations for older adults at risk for falls. This way, you’ll better understand how SPRINT’s findings might inform the BP goals that you and your doctors choose to pursue.

Here’s what this post will cover: 

  • What is currently considered “normal” blood pressure for older adults in their 60s, 70s, 80s
  • What the latest blood pressure guidelines recommend
  • What to know about the landmark SPRINT blood pressure in older adults trial, including who was included and excluded, and what type of BP medications were used most often
  • What the actual likelihood of benefits and harms was within SPRINT, and what you might expect if you are similar to the SPRINT participants
  • Why you probably need to make a change in how your blood pressure is measured before considering a SPRINT-style systolic BP goal of 120
  • My own approach and how to avoid over-treatment of high blood pressure

I also cover the details of this article in video form on my Youtube channel: 

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: blood pressure, medication management

10 Things to Know About Delirium

by Leslie Kernisan, MD MPH

Pop quiz: What aging health problem is extremely common, has serious implications for an older person’s health and wellbeing, and can often – but not always – be prevented?

It’s delirium. In my opinion, this is one of the most important aging health problems for older adults to be aware of. It’s also vital for family caregivers to know about this condition, since families can be integral to preventing and detecting delirium.

In this article, I’ll explain just what delirium is, and how it compares to dementia. Then I’ll share 10 things you should know, and what you can do.

What is Delirium

Delirium is a state of worse-than-usual mental confusion, brought on by some type of unusual stress on the body or mind. It’s sometimes referred to as an “acute confusional state,” because it develops fairly quickly (e.g., over hours to days), whereas mental confusion due to Alzheimer’s or another dementia usually develops over a long time.

The key symptom of delirium is that the person develops difficulty focusing or paying attention. Delirium also often causes a variety of other cognitive symptoms, such as memory problems, language problems, disorientation, or even vivid hallucinations. In most cases, the symptoms “fluctuate,” with the person appearing better at certain times and worse at other times, especially later in the day.

Delirium is usually triggered by a medical illness, or by the stress of hospitalization, especially if the hospitalization includes surgery and anesthesia. However, in people who have especially vulnerable brains (such as those with Alzheimer’s or another dementia), delirium can be provoked by medication side-effects or less severe illnesses.

It’s much more common than many people realize: about 30% of older adults experience delirium at some point during a hospitalization.

That confusion after surgery that older adults often experience? That’s delirium.

The way your elderly mother with dementia gets twice as confused when she has a urinary tract infection? That’s delirium too.

Or the common phenomenon of “ICU psychosis”? That too is delirium.

What Causes Delirium?

In older adults, delirium often has multiple causes and contributors. These can include:

  • Infection (including UTI, pneumonia, the flu, COVID)
  • Other serious medical illness (e.g. heart attack, kidney failure, stroke, and more)
  • Metabolic imbalances (e.g. abnormal blood levels of sodium, calcium, or other electrolytes)
  • Dehydration
  • Medication side-effects
  • Sleep deprivation
  • Uncontrolled pain
  • Sensory impairment (e.g. poor vision and hearing, which can worsen if the person is lacking their usual glasses or hearing aids)
  • Alcohol withdrawal

Delirium vs. Dementia

People often confuse delirium and dementia (such as Alzheimer’s disease), because both conditions cause confusion and appear superficially similar. Furthermore, people with dementia are actually quite prone to develop delirium. That’s because delirium is basically a reflection of the brain going haywire when it gets overloaded by the stress of illness or toxins, and brains with dementia get overloaded more easily.

In fact, the more vulnerable a person’s brain is, the less it takes to tip them into delirium. So a younger person generally has to be very very sick to become delirious. But a frail older person with Alzheimer’s might become delirious just from being stressed and sleep-deprived while in the hospital.

Why Delirium is Such an Important Problem

There are three major reasons why delirium is an important problem for us all to prevent, detect, and manage.

First, delirium is a sign of illness or stress on the body and mind. So if a person becomes delirious, it’s important to identify the underlying problems – such as an infection or untreated pain – and correct them, so that the person can heal and improve.

The second reason delirium is important is that a confused person is at higher risk for falls and injuries during the period of delirium.

The third reason is that delirium often causes serious consequences related to health and well-being.

In the short term, delirium increases the length of hospital stays, and has been linked to a higher chance of dying during hospitalization. In the longer term, delirium has been linked to worse health outcomes, such as declines in independence, and even acceleration of cognitive decline.

Now let’s cover 10 more important facts you should know about delirium, especially if you’re concerned about an aging parent or other older relative.

10 Things to Know About Delirium, and What You Can Do

1.Delirium is extremely common in aging adults.

Almost a third of adults aged 65 and older experience delirium at some point during a hospitalization, with delirium being even more common in the intensive care unit, where it’s been found to affect 70% of patients. Delirium is also common in rehabilitation units, with one study finding that 16% of patients were experiencing delirium.

Delirium is less common in the outpatient setting (e.g. home, assisted-living, or primary care office). But it still can occur when an older adults gets sick or is affected by medications, especially if the person has a dementia such as Alzheimer’s.

What to do: Learn about delirium, so that you can help your older loved ones reduce the risk, get help quickly if needed, and better understand what to expect if someone does develop delirium. You should be especially be prepared to spot delirium if your parent or loved one is hospitalized, or has a dementia diagnosis. Don’t assume this is a rare problem that probably won’t affect your family. For more on hospital delirium, see Hospital Delirium: What to know & do.

2. Delirium can make a person quieter.

Although people often think of delirium meaning as a state of agitation and or restlessness, many older delirious people get quieter instead. This is called hypoactive delirium. It’s still linked with difficulty focusing attention, fluctuating symptoms, and worse than usual thinking. It’s also linked with poor outcomes. But it’s of course harder for people to notice, since there’s little “raving” or restlessness to catch people’s attention.

What to do: Be alert to those signs of difficulty focusing and worse-than-usual confusion, even if your older person seems quiet and isn’t agitated. Tell the hospital staff if you think your relative may be having hypoactive delirium. In the hospital, it’s normal for older patients to be tired. It’s not normal for them to have a lot more difficulty than usual making sense of what you say to them.

3. Delirium is often missed by hospital staff.

Despite the fact that delirium is extremely common, it is often missed in hospitalized older adults, with some reports estimating it’s being missed 70% of the time. That’s because busy hospital staff will have trouble realizing that an older person’s confusion is new or worse-than-usual. This is especially true for people who either look quite old – in which case hospital staff may assume the person has Alzheimer’s – or have a diagnosis of dementia in their chart.

What to do: You must be prepared to speak up if you notice that your family member isn’t in his or her usual state of mind. Hypoactive delirium is especially easy for hospital staff to miss. Hospitals are trying to improve delirium prevention and detection, but we all benefit when families help out. Remember, no hospital person knows your older person the way that you do.

4. Delirium can be the only outward sign of a potentially life-threatening problem.

Although delirium can be brought on or worsened by “little things” such as sleep deprivation or untreated constipation, it can also be a sign of a very serious medical problem. For instance, older adults have been known to become delirious in response to urinary tract infections, pneumonia, and heart attacks.

In general, it tends to be older persons with dementia who are most likely to show delirium as the only outward symptom of a very serious medical illness. But whether or not your older relative has dementia, if you notice delirium, you’ll want to get a medical evaluation as soon as possible.

What to do: Again, if you notice new or worse-than-usual mental functioning, you must bring it up and get your older loved one medically evaluated without delay. For older adults who are at home or in assisted -living, you should call the primary care doctor’s office, so that a nurse or doctor can help you determine whether you need an urgent care visit versus an emergency room evaluation.

5. Delirium often has multiple underlying causes.

In older adults with delirium, we often end up identifying several problems that collectively might be overwhelming an older person’s mental resilience. Along with serious medical illnesses, common contributors/causes for delirium include medication side effects (especially medications that are sedating or affect brain function), anesthesia, blood electrolyte imbalances, sleep deprivation, lack of hearing aids and glasses, and uncontrolled pain or constipation. Substance abuse or withdrawal can also provoke delirium.

What to do: To prevent delirium, learn about common contributors and try to avoid them or manage them proactively. For instance, if you have a choice regarding where to hospitalize an older person, some hospitals have “acute care for elders” units that try to minimize sleep deprivation and other hospital-related stressors. If your older relative does develop delirium, realize that there is often not a single “smoking gun” when it comes to delirium. A good delirium evaluation will attempt to identify and correct as many factors as possible.

6. Delirium is diagnosed by clinical evaluation.

To diagnose delirium, a doctor first has to notice – or be alerted to – the fact that a person may not be in his or her usual state of mind. Experts recommend that doctors then use the Confusion Assessment Method (CAM), which describes four features that doctors must assess. Delirium can be diagnosed if a patient’s symptoms include “acute onset and fluctuating course,” “difficulty paying attention,” and then either “disorganized thinking” or “altered level of consciousness.”

Delirium cannot be diagnosed by lab tests or scans. However, if an older adult is diagnosed with delirium, doctors generally should order tests and review medications, in order to identify factors that have caused or worsened the delirium.

What to do: Again, the most important thing for you to do is to get help for your loved one if you notice worse-than-usual confusion or difficulty focusing. Although families have historically not had a major role in delirium diagnosis, delirium experts have developed a family version of the CAM (FAM-CAM), which is designed for non-clinicians and has been shown to help detect delirium.

7. Delirium is treated by identifying and reversing triggers, and providing supportive care.

Delirium treatment requires a care team to take a three-pronged approach.

  1. Health providers must identify and reverse the illness or problems provoking the delirium.
  2. They have to manage any agitation or restless behavior, which can be tricky since a fair number of sedating medications can worsen delirium.
    1. The safest approach is a reassuring presence (family is best, but hospitals sometimes also provide a “sitter”) to be with the person, plus improve the environment if possible (e.g. a room with a window and natural light).
    2. The once-popular practice of physically restraining agitated older adults has been shown to sometimes worsen delirium, and should be avoided if possible.
  3. The care team needs to provide general supportive care to help the brain and body recover.

What to do: The reassuring presence of family is often key to providing a supportive environment that promotes delirium recovery. You can also help by making sure your loved one has glasses and hearing aids, and by alerting the doctors if you notice pain or constipation. Ask the clinical team how you can assist, if restlessness or agitation are an issue. Bear in mind that physical restraints should be avoided, as there are generally safer ways to manage agitation in delirium.

8. It can take older adults a long time to fully recover from delirium.

Most people are noticeably better within a few days, once the delirium triggers have been addressed. But it can take weeks, or even months, for some aging adults to fully recover.

For instance, a study of older heart surgery patients found that delirium occurred in 46% of the patients. After 6 months, 40% of those who had developed delirium still hadn’t recovered to their pre-hospital cognitive abilities.

What to do: If your parent or someone you love is diagnosed with delirium, don’t be surprised if it takes quite a while for him or her to fully recover. It’s good to be prepared to offer extra help during this period of time. You can facilitate recovery by creating a restful recuperation environment that minimizes mental stress and promotes physical well-being.

9. Delirium has been associated with accelerated cognitive decline and with developing dementia.

This is unfortunate, but true, especially in people who already have Alzheimer’s or another type of dementia. A 2009 study found that in such persons, delirium during hospitalization is linked to a much faster cognitive decline in the following year. A 2012 study reached similar conclusions, estimating that cognition declined about twice as quickly after delirium in the hospital.

In older adults who don’t have dementia, studies have found that delirium increases the risk of later developing dementia.

What to do: Experts aren’t sure what can be done to counter this unfortunate consequence of delirium, other than to try to optimize brain well-being in general. (For this, I suggest avoiding risky medications, getting enough exercise and sleep, being socially and intellectually active, and avoiding future delirium if possible; learn more here.)

The main thing to know is that delirium has serious consequences, so it’s often worth it for a family to be careful about surgery in an older person, and it’s good to learn about delirium prevention (see below).

10. Delirium is preventable, although not all cases can be prevented.

Experts estimate that delirium is preventable in about 40% of cases. Preventive strategies are meant to reduce stress and strain on an older person, and also try to minimize delirium triggers, such as uncontrolled pain or risky medications.

In the hospital setting, programs such as the Hospital Elder Life Program (HELP) for Prevention of Delirium have been shown to work. For ideas on how families can help, see this family tip sheet from the Hospital Elder Life Program. For instance, families can help reorient a relative in the hospital, ensure that glasses and hearing aids are available, and provide a reassuring presence to counter the stress of the hospital setting.

Less is known about preventing delirium in the home setting. However, since taking anticholinergic medications (such as sedating antihistamines) has been linked with hospitalizations for confusion, you can probably prevent delirium by learning to spot risky medications your parent might be taking.

What to do: To prevent hospital delirium, carefully weigh the risks and benefits before proceeding with elective surgery. If your older loved one must be hospitalized, choose a facility using the HELP program or with an Acute Care for Elders unit if possible. Be sure to read HELP’s tips for families on preventing hospital delirium.

Remember, delirium is common and can be the only outward sign of a serious medical problem.

By educating yourself and helping your older loved ones be proactive about prevention, you can reduce the chance of harm from this condition.

And if you do notice symptoms of delirium, make sure to tell the doctors! This will help your parent get the evaluation and treatment that he or she needs.

Useful Online Resources Related to Delirium

Here are links to some of the resources I reference in the article:

  • A study (one of many) finding that delirium is linked to worse health outcomes in the elderly
  • A study of older adults in the Intensive Care Unit, finding that 43.5% had hypoactive delirium
  • An article finding that older patients do better when they are hospitalized in an “Acute Care for Elders” unit (a special hospital ward tailored towards protecting older adults from hospital complications; they are great!)
  • An explanation of the Confusion Assessment Method, which experts recommend doctors use to diagnose delirium
  • A description of the Family-CAM, which experts developed to help family caregivers detect delirium
  • A study finding that delirium accelerates cognitive decline in Alzheimer’s; a follow-up study finding that people with dementia decline twice as quickly after having delirium (!) is here.
  • Tips on how family caregivers can prevent delirium, from the Hospital Elder Life Program

Last but not least, for my previous posts on delirium:

  • Delirium: How Caregivers Can Protect Alzheimer’s Patients
  • Hospital Delirium: What to Know and Do
  • How to Maintain Brain Health: the IOM Report on Cognitive Aging

This article was reviewed and updated in January 2025. 

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: delirium, dementia

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