WHEN THE ELDERLY HAVE A SUDDEN ONSET OF CONFUSION, IS ITS DEMENTIA OR DELIRIUM?

(Part II)

Delirium is a medical emergency pointing to an abnormal physical condition or response.  It is characterized by the sudden onset and rapid fluctuations in change of mental status.  It may be a response to:

  • An infection – post surgery, urinary, urinary or bowel retention
  • A head injury/trauma – fall
  • Elevated temperature
  • Metabolic problem – highest incident – 20-40% of cases of delirium result from a organ failure (liver, kidney) diabetes, hyperthyroidism, hypothyroidism
  • Medications – antipsychotics, sedatives, anti-inflammatory, antihistamines, anti-depressants ( most common cause of reversible delirium)
  • Acute vascular incident
  • Alcohol withdrawal

While there are many possible causes of delirium. What is known is that the elderly population not only experiences the highest incident of delirium, but also the poorest outcomes. Studies indicate that around 50% of the elderly transferred from a hospital setting to a nursing home setting are suffering from delirium.

The hospital tells the family that they must discharge the elder, and the family thinks how can we possibly take care of Dad at home, he is so confused. So the elder may go prematurely to a nursing home, only to have the staff there begin to medicate him for the various behaviors they witness. This can create an added burden on the already confused elder suffering from delirium.

There is no simple test for delirium

Dementia is not an illness, but rather a group of symptoms associated with an illness. Likewise delirium is not an illness itself, but also a group of symptoms associated with the illness. The symptoms of dementia are very much like the symptoms of delirium.

  • Memory loss
  • Hallucinations (only visual – hearing voices would not indicate delirium)
  • Highly distracted
  • Confused thinking
  • Disoriented to time, date and place
  • Not capable of new learning – will ask the same questions over and over – not retaining the answers

However the elderly suffering from delirium will have newly acquired language difficulties. Less coherent communication skills as well as be less able to name objects correctly and suffer from a decrease in writing skills.

The family – very important part of the health-care team

The family is there to communicate the elder’s history. Even, if you find yourself telling the same story over and over to everyone who comes into the elder’s room. It is of most importance that the health-care team knows that this is a sudden change in condition. And also what is normal for this elder.

The family member is there to provide support, as I needed to do for my Dad when he experienced bouts of delirium. The elder needs a supportive presence to provide repeated orientation cues. Monitor the environment to reduce distractions (especially when the elder is in the hospital). Use clear language, avoiding pronouns while introducing staff to the elder by their name. The elder needs explanation and reassurance until their normal level of function returns.

See also Blogs: Auguste Deter, First Person Diagnosed with Alzheimer’s Disease

(January 3, 2010)

What is Dementia? Reversible Dementia, Irreversible Dementia, Vascular Dementia and Alzheimer’s Disease?      (December 17, 2009)

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Comments

  1. This is a very helpful article giving helpful recomendations as well as clearly defining the problems surrounding the person experiencing the issues. My mother is 87 and her ability to follow a conversation is almost nonexistant as is her verbal expression of the problem. I am new as her caregiver and mainly just frustrated as this has happened over the last 3 monthss time. After reading this I can see there were other things leading up to this that went unnoticed.
    thank you for good straight information

  2. Thank you for being here, especially tonight. Our family needed concise information to know what information to take to our Mother’s doctor Monday and also to have some idea of what might be happening to her.
    You are the most clear and compassionate.
    thank you.

  3. beth bedard says:

    Hi – we ( my siblings & I) have an 81 yr old father who was recently diagnosed with severe dementia. We are finding this very hard to believe as 4 weeks ago we saw him and he was more than FINE. as a matter of fact he drove himself from Iroquois Falls to Sudbury, from there on to Pembroke and from there back to Iroquois Falls – BY HIMSELF, WITH NO PROBLEMS. This diagnosis does not make sense to us. Something has been missed and we are very frustrated.

  4. Susan Greenberg says:

    My Mother is 88 yrs old, has had a mild dementia for 2 yrs but able to function and live on her own. just last month she started to fall and lost 8 lbs. Suddenly she had this crazy apathy and did not get out of bed or eat. I got a urine specimen and it showed a UTI, she since has been treated with 4 different antibiotics, yet the infection, now low grade is still there. Worse yet, she has started to babble, at times. I had her in an ALF for respite care but she fell again. I took her to the ER as her MD was being passive. In the month my Mother went from being able to walk around the block, feed, bathe ect. to barely able to get out of bed. She has gone in a rapid decline. She is now in the hospital on IV antibiotics but still seems so far gone. All her labs tests are fine, a CAT of brain, ultrasound of kidneys are good. Normal blood values, just a mild UTI bacteria at 50,000. I am puzzled as to what on earth else is it. Looking for help

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