A Family's Guide to Hospital Delirium

Hospital delirium is a common yet often misunderstood condition affecting older adults. It's crucial for families and caregivers to understand delirium, its causes, and how to advocate for their loved ones in the hospital setting. This guide provides essential information and practical steps to navigate this challenging situation.

Understanding Hospital Delirium

Delirium is a state of worsened mental function brought on by illness or stress. It's not the same as dementia, although people with dementia are at higher risk. Often mistaken for normal aging or "hospital confusion," delirium can have serious consequences if left unaddressed.

Why Delirium Matters

• Common: Delirium affects up to half of older hospitalized patients.

• Serious: It's linked to falls, longer hospital stays, accelerated cognitive decline, and increased mortality.

• Often Missed:  Hospital staff may not recognize delirium, especially the "quiet" type where patients become withdrawn.

• Multifactorial:  Delirium usually has multiple contributing factors, requiring a comprehensive approach to treatment and prevention.

Preventing Hospital Delirium

While not all delirium is preventable, these steps can significantly reduce the risk:

1. Optimize Sleep

• Minimize nighttime disruptions like unnecessary blood pressure checks.

• Request a quiet room.

• Avoid sleeping pills:  They can worsen delirium. Explore non-drug relaxation methods like music or massage.

2. Address Sensory Impairments

• Ensure your loved one has access to glasses and hearing aids.

3. Provide Familiarity and Support

• Bring familiar objects like family photos.

• Offer reassuring companionship to help with reorientation.

4. Avoid Overstimulation

• Minimize mental and emotional stress.

• Keep communication simple and clear.

5. Encourage Mobilization

• Promote safe physical activity as soon as possible.

• Minimize the use of bladder catheters.

6. Manage Pain and Discomfort

• Communicate any pain or constipation to the medical staff.

Recognizing Delirium

Be vigilant for any changes in mental state, including:

• Sudden confusion or disorientation

• Difficulty concentrating

• Changes in personality or behavior

• Restlessness or agitation (or conversely, withdrawal and lethargy)

• Incoherent speech

Common Causes of Hospital Delirium

Several factors can trigger delirium, often working in combination:

• Electrolyte imbalances

• Infections (pneumonia, sepsis, UTIs)

• Surgery and anesthesia

• Dehydration

• Medication side effects or drug interactions

• Withdrawal from alcohol or drugs

• Blood glucose abnormalities

• Kidney or liver problems

• Untreated pain or constipation

• Sensory impairments

• Stress and unfamiliar environment (especially for those with dementia)

Advocating for Your Loved One

If you suspect delirium, communicate your concerns to the medical staff immediately. Ask about their evaluation and management plan. Key questions to ask:

• What are the possible causes of the delirium?

• What tests will be performed?

• What is the treatment plan?

• How will the delirium be monitored?

Treatment of Hospital Delirium

Treatment focuses on:

• Identifying and addressing underlying causes: This may involve treating infections, correcting imbalances, or adjusting medications.

• Supportive care: Creating a calm and restorative environment.

• Preventing injury: Managing difficult behaviors without resorting to physical restraints if possible. Special "delirium rooms" and trained staff can be helpful.

• Medication as a last resort:  If necessary, low doses of antipsychotics may be used. Benzodiazepines are generally avoided as they can worsen confusion.

Empowering Caregivers

By understanding delirium, its causes, and its treatment, families and caregivers can play a vital role in ensuring their loved ones receive appropriate care and support during hospitalization. Your vigilance and advocacy can make a significant difference in their recovery.