A 68-year-old patient is diagnosed with moderate dementia after multiple strokes
This question came up during a Q & A session, as we were discussing the Choosing Wisely recommendation to avoid tying down older adults who become confused during a hospitalization. Show
Delirium is a common and very important problem for all older adults in the hospital. It doesn’t just happen to people with Alzheimer’s or a dementia diagnosis. (And, it’s not the same thing.) But many family caregivers have hardly heard of hospital delirium. This is too bad, since there’s a lot that family caregivers can do to prevent this serious complication, or at least prevent an older loved one from being physically restrained if delirium does occur. In this post, I’ll review what older adults and families absolutely should know about hospital delirium. And, we’ll cover some of the things you can do if it happens to your loved one. Why hospital delirium is so important to know aboutDelirium is a state of worse-than-usual mental function, brought on by illness or some kind of stress on the body or mind. Although people with dementia are especially prone to develop delirium, delirium can and does affect many aging adults who don’t have Alzheimer’s or another dementia diagnosis. Here are some facts that all older adults and family caregivers should know:
To summarize, delirium is common, serious, and often missed by hospital staff. Fortunately, there’s a lot that you can do as a family caregiver. In particular, you can help your loved one more safely get through a hospitalization by:
How to prevent hospital deliriumNow, not all hospital delirium can be prevented. Some people are very sick, or very prone to delirium, and it’s certainly possible to develop delirium even when all triggers and risk factors have been addressed. Furthermore, many older adults are already delirious when they first get hospitalized. Still, there are steps that can be taken to reduce the chance of a bad delirium. Experts estimate that about 40% of delirium cases are preventable. The ideal is to be hospitalized in a facility that has already set up a multi-disciplinary delirium prevention approach, such as the Hospital Elder Life Program. Other hospitals have Acute Care for Elders units (also called “ACE” units) which also provide a special environment meant to minimize the hospital stressors that can tip an older person into delirium. For elective surgeries, such as joint replacements, look for a hospital that has set up a geriatric co-management program for orthopedics, such as this one. Here are some specific interventions that help reduce delirium, and how you can help as a caregiver:
For more useful ideas, see this family tip sheet from the Hospital Elder Life Program. If you think your loved one has developed delirium, make sure the doctors and nurses know about it. You may want to ask them what their plan is for evaluating and managing it. This will help you stay up-to-speed on the hospital course. Some hospitals may even interview families to help diagnose delirium, using something called the FAM-CAM (short for Family Confusion Assessment Method) tool. The Confusion Assessment Method is generally considered the gold standard for diagnosing delirium. How hospital delirium is treatedTo treat delirium, here’s what the doctors and nurses usually do:
What you can do if an older person becomes delirious in the hospitalIt can be scary to see an older person confused in the hospital, especially if you know that delirium can have serious consequences. First and foremost, try not to panic. It’s time to hope for the best. Focus on doing what you can to help the delirium resolve. As a family caregiver, you can play a very important role in providing a supportive and reassuring presence during an older person’s delirium. You can also:
If you are of the really vigilant and proactive type, you may want to double-check that your loved one isn’t getting any sedatives or anticholinergic medications that make confusion worse. Even though these medications are risky for hospitalized older adults, it’s not uncommon for them to be prescribed! 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. In some cases, the person never recovers back to their prior normal. For more on delirium, see:
You can also listen to our podcast episode, featuring leading delirium researcher Dr. Sharon Inouye, the founder of the Hospital Elder Life Program: 062 – Interview: Preventing Hospital Delirium & Maintaining Brain Health This article was first published in 2014, and was last updated by Dr. K in March 2022. As we are now at 200+ comments, the comments section has been closed to new comments. Thank you! Which action would help the nurse determine whether a new patient's confusion is caused by dementia or delirium?Use the Confusion Assessment Method (CAM) to identify whether this patient has delirium.
What are some coping strategies for dementia?Coping Strategies. Anticipate misinterpretation by your patient. ... . Remember that all behavior has a purpose. ... . Enjoy the good times. ... . Reminisce about the past and encourage discussions about people and places that are familiar and evoke pleasant feelings for both you and your patient. ... . Be flexible.. What happens in the moderate stage of dementia?During the moderate dementia stage of Alzheimer's disease, people grow more confused and forgetful and begin to need more help with daily activities and self-care. People with the moderate dementia stage of Alzheimer's disease may: Show increasingly poor judgment and deepening confusion.
Which type of dementia is the second most common and usually happens after a stroke or series of small strokes?Vascular dementia happens when the blood supply to parts of your brain becomes reduced. This can be due to blood vessels being clogged, a stroke or a series of small strokes. Over time, areas of brain cells stop working, leading to symptoms of dementia. Vascular dementia affects different people in different ways.
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