Pop quiz: What senior 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, which affects about 30% of seniors during hospitalization. (Rates are much higher if there’s been a surgery or if the person is in the intensive care unit.)
People sometimes refer to delirium as “post-operative confusion,” or “ICU psychosis” or even “hospital dementia.”
Delirium is extremely important for family caregivers to learn about, because families are often the first to notice that senior isn’t himself or herself.
So I’ve written a comprehensive article for A Place for Mom, covering the definition of delirium and all the essential things you should know. You can find it here:
In this article, I explain:
- What is delirium, including symptoms and causes,
- How delirium differs from dementia,
- Why delirium is such an important problem to prevent and detect in seniors.
I also cover ten important things to know — and do! — about delirium:
- The statistics on how common delirium is in seniors,
- That seniors with delirium often become quieter (this is called hypoactive delirium), which is harder to detect but just as dangerous,
- That delirium is often missed by hospital staff,
- That delirium can be the only outward sign of a potentially life-threatening medical problem,
- That delirium often has multiple underlying causes,
- How delirium is diagnosed,
- How delirium is treated,
- That it often takes seniors a long time to fully recover from delirium,
- That delirium is associated with accelerated cognitive decline, and with developing dementia,
- How to prevent delirium.
To get the details on these ten things to know and do, read the full article here.
And then visit one of my favorite family sites for delirium, which is the Hospital Elder Life Program website.
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 seniors in the Intensive Care Unit, finding that 43.5% had hypoactive delirium
- An article finding that seniors do better when they are hospitalized in an “Acute Care for Elders” unit (a special hospital ward tailored towards protecting seniors 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
If you have any additional questions regarding delirium, please post them below!
Have you any help for families taking home their loved one who has delirium? I am living the experience with my sister’s and brothers and it would appear that there is no help from the mental health! Just keep getting told to seek social care but it’s only happening at night from 12:30 to 4:30am.
Usually our advice to families is to continue with supportive care: a reassuring, restorative home environment, minimizing overstimulation, etc. It’s usually best to not argue with anything irrational or odd that is said, and instead try to soothe the person.
If the confusion seems to be getting worse, then you should bring it up with the doctor. Sometimes an older person’s underlying illness relapses, or a new problem arises that might provoke delirium.
Has your sibling recently been ill and diagnosed with delirium? Was there pre-existing Alzheimer’s or another dementia? Symptoms just during the night would make me wonder about an older person developing some day-night confusion, or perhaps even some sundowning.
You might get some ideas on how to manage nighttime confusion or sleep difficulties in one of these articles:
5 Top Causes of Sleep Problems in Seniors
How to Manage Sleep Problems in Dementia
Definitely talk to your sibling’s doctor about this problem!
Thank you for the very informative articles. Great food for thought!
Glad you found this helpful!
Thank you so much for posting this article. My father is currently in the hospital, and is suffering from hospital induced dementia. My family is heartbroken to see this rapid decline in his mental state and the hospital staff who just wants to pump him up with medication to make his sleep. They even raised his bed and then tilted it downward so his head was below his feet. We asked the nurses why this was done and they advised us this is common practice to keep the patient from trying to get out of bed.
This article is so timely and comforts me and my sisters as we now have a little more knowledge about this condition.
Glad to be helpful. So sorry that your father has been experiencing this problem!
You may want to ask more questions about what medications he is being given to “make him sleep.” Hospitals sometimes administer sedating antihistamines or benzodiazepine sedatives for this purpose. But in geriatrics, we generally try to avoid using these, as they can make confusion and delirium worse.
Good luck, I hope your father starts feeling better soon. Most people do eventually get better, but it can take time, and it’s a stressful experience for everyone while the delirium is bad.
Hi, Thank you for your article. My father is 73 had spine surgery in August, went to a rehab facility after where he got a UTI which landed him in the hospital, he was in the hospital for a week and had acute delirium. Ultimately went back to the rehabilitation facility where things begin to clear up, and got better once he got home. He was at home for about a month, and got another UTI which landed him back in the hospital. At the hospital he had a very bad reaction to medication they gave him which landed him in the ICU. He has since again to have the delirium again. But worse this time as it’s been a longer Hospital stay. They would like to transfer him to a Skilled Nursing Facility, but we’re wondering if the delirium will clear in that type of setting or not? Thank you.
So, in principle delirium can clear in any type of setting. What affects delirium clearing is:
– Did the provoking illness or problem get treated?
– Are aggravating factors (which we can call delirium contributors) being minimized? Common delirium aggravators include poorly treated pain, constipation, dehydration, not having hearing aids or glasses, not getting out of bed enough, and so forth.
– Is the person able to get enough rest and recuperation?
– How resilient was the person’s brain before developing delirium? How physically resilient is the person?
Your father has unfortunately had three hospitalizations in the past few months, and was sick enough to be in the ICU this last time. This means he’s pretty physically and mentally depleted. People like him can recover, but the more depleted and weakened a person is, the longer it can take to recover, and the more vulnerable the person is to tipping back into delirium again.
The trouble with a skilled nursing facility (SNF) is that many older adults do not find them very restorative. Depending on how they are run and staffed, the situation may even aggravate a person’s mental state. It’s also possible for an older person in a SNF to develop a new complication or infection.
Many SNFs are not ideal for people who have been delirious. In terms of recovering from delirium, it’s probably better for an older person to go home and get skilled rehab services from home health. But that’s only possible if a person is medically stable enough, and if family members are able to provide a lot of support and assistance, especially in the first days home. So, you may have to go with the SNF. Do try to stay as involved as possible, as that can help with recovery.
I hope he starts to get better soon. Good luck!
Thank You! These articles have all been very helpful
Glad you are finding them helpful!
Our 82 year old Mum has been in ICU / HDU for about 10 weeks – and is “confused” but only sometimes. She’s a sharp lady normally, and sometimes she’s still like that – still has her sense of humour etc. You have a perfectly normal conversation and then, out of nowhere she asks why her mother (died 30 years ago) hasn’t been in to see her or where her husband (died 4 years ago is) – What to say? My sister, has had training for dealing with dementia patients, said she was told it is best to not upset her so she just fluffs the answers and says “Oh, they came whilst you were asleep” whilst a nurse on HDU told me to “keep her in reality” – just tell her “They passed away 30 years ago and you know this.”
Which is the correct approach? (Our hearts are breaking here!)
Before hospital, she was starting to get very forgetful but that’s all. She’s had a nasty UTI and has been on mega anti-biotic runs.
Will she recover? Chances? Anything else we can do to help?
I’m sorry to hear about your mom’s situation, I can imagine how hard it must be to see her still confused at times.
I would agree with your sister: the general dictum when it comes to dementia and delirium is that you should not insist on getting someone grounded in reality, it’s much more important to help them feel reassured and to avoid stressing them.
Now, in hospitals we do sometimes encourage staff and family to help keep the patient “oriented” to what is going on, with gentle reminders about where they are, what’s been happening. This might be part of what the nurse is referring to.
I usually recommend that people pay attention to the effect of their words. It can take a little trial and error to find out what the most reassuring and constructive approach is.
In terms of whether she’ll recover: many older people do recover once their health conditions stabilizes and they get out of the hospital. It can take a long time (weeks or often even months), especially if they were delirious for a long time, or if they had some cognitive impairment prior to becoming delirious.
If you haven’t yet read them, I would recommend going through the comments on the Hospital Delirium article, as they are relevant to your situation and might give you some hopeful ideas. Good luck!
My 60 year old husband had major surgery a week ago, and now is having profound hallucinations. Initially the doctors thought it was the narcotic pain medication, however, he has not taken any all day, and his hallucinations are getting worse. I’m likely going to return to the hospital, as this is scary for all of us.
Sorry to hear of this. Yes, if his symptoms are getting worse, then it’s definitely a good idea to alert his doctors and get more help assessing what might be causing or worsening any delirium symptoms. good luck!
My 85 year old father, who we recently moved into a highly rated and very nice assisted living facility, has been battling congestive heart failure (after a serious heart attack 5 years ago) along with kidney failure stemming from the chf. His short-term memory has been slowly declining.
Yesterday, my brother called him, and for about 10 minutes, our usually subdued father chatted on and on about currently being on a ship out at sea that had been hijacked by pirates. After they ended the call and my brother called to tell me about it, I called my dad.
He greeted me enthusiastically, immediately letting me know that he was “on a ship out at sea that had been taken over by pirates”, but he “got lucky and saved the day when the head pirate turned his back” on him, so Dad was able to hit the pirate over the head.
He told me he was in the Pacific when I asked him which sea he was in. He provided details such as he had a gun, but so did the pirates, and during our surreal conversation, Dad shot at them. He couldn’t remember how he ended up on this hijacked ship, but remembered he’d been on board since that morning. He remarked that the pirates, who were now captaining the ship “had no idea what they were doing;” that he had been “extremely lucky,” and agreed with me that this was an amazing adventure!
Although he had a lot of laughter in his voice while describing this current event, he said it wasn’t that much fun. Before he ended the call, I told him to please be careful. Being serious, he promised that he would be very careful.
His cognitive decline over the past several months has been at the worst forgetting what he ate for dinner, or if my brother had visited him earlier that day.
Typically, our telephone conversations lately have been brief and very basic. He hasn’t been very talkative at all, with either my brother or me.
That’s another reason why the pirate conversation was so weird: besides the content, he was energetic, laughing, animated, happy to answer questions, and instead of the usual 3 minute mostly one-sided conversation, these two calls lasted 20 minutes with him doing most of the talking.
What was this? My brother left a message for the nurse but hasn’t heard anything back yet.
Hm, interesting story.
Hard to say just what caused this, or how worried you should be. Usually, a sudden change in thinking or mental abilities is for the worse; this one sounds like an odd combination of “better” in that your father had more energy and animation and verbal output, but potentially “worse” in that he is telling an odd uncharacteristic story, which might reflect more confusion than usual.
One does hear about people with dementia having a random “perked up” moment every now and then like this…the brain and body are mysterious, we don’t understand everything that happens.
I hope he at least continues to be in good spirits. If you are worried about possible delirium, you could ask to have him further evaluated, or at least monitored a little more closely for the next few days. good luck!
My 85 year old father developed an infected toe. After many visits to various doctors, it was determined his leg had poor circulation and his foot had very little blood flow (no pulse).
During the procedure to insert a stent at the hip, the sedative Versed caused my father to become very combative, a side effect seen previously. We have no idea why Versed was used again. The procedure could not be completed.
For a few days he was somewhat confused but okay, and then he fell getting up from the couch.
After that he was very combative, restless, and stopped sleeping nearly completely. He spent a week in the hospital getting somewhat stabilized and then was sent to my sister’s, along with our mom. he was there for two weeks, displaying sundowners with worse and better days. Again no sleeping. After appearing to be improving, he had to return to the hospital after becoming very combative and agitated. At the hospital he broke his shoulder jumping out of bed, while his toes began to die.
The psych ward dosed him into nearly total unconsciousness and at that point he had a successful vascular bypass, then the toes were removed. A bout of sepsis followed but it responded to antibiotics.
He has never really awaken since he was drugged unconscious. The foot is healing but now he doesn’t even swallow and needs his mouth suctioned. All medications are being stopped, aside from antibiotics and minor pain medication.
Prior to this, my father could mow the grass, did his income taxes for 2018, and did the shopping for himself and mom.
Could this have started from from Versed? It’s been about 2 months since it began, and though he had some totally normal moments, he has been mumbling and mostly sleeping the last week.
No one at the hospital seems to know whats wrong with him. Brain shows no damage but his circulatory system is calcified heavily.
The only hope now is that after the leg fully heals, he will return to normal.
I share this mainly to warn others that Versed is not the best sedative for elderly patients.
Thank you.
Sorry for delayed response and thank you for sharing your story.
Versed is a benzodiazepine used for sedation during procedures. All benzodiazepines are considered risky in older adults and can cause confusion or even paradoxical agitation in some older adults. In other older adults, they cause sedation and decrease agitation.
I don’t know whether I’d attribute his mental decline entirely to Versed. Probably his brain was vulnerable to begin with, and then the combination of infection, hospital/surgery stress, and sedatives tipped him into delirium and further cognitive decline.
I hope he improves once his leg heals. Good luck and take care!