Everyone forgets where they put their keys or if they closed the garage door, but when do forgetfulness and confusion become a bigger problem, and how can we detect it?
A sudden onset of confusion caused by a medical condition is known as delirium, and it can have serious consequences. Though delirium can happen to anyone, it is most concerning in older adult patients. It is an acute change, one that happens in a matter of hours or days, and should be considered a medical emergency.
Why Should I Worry About Delirium?
Especially in older adults, it may seem normal or even stereotypical to be confused, but according to Natalie Sanders, DO, a geriatrician at 麻豆学生精品版, these events shouldn鈥檛 be shrugged off. 鈥淐onfusion or a little bit of slipped memory is common in a lot of adults, but it鈥檚 not normal,鈥 she says.
One of the big drivers of trying to prevent delirium is that it鈥檚 associated with so many bad outcomes, according to Sanders. Among those outcomes are increased rates of mortality, length of stay, complications, falls, and functional decline. After experiencing delirium, patients may not be able to get back to their baseline abilities and may need more care from family members or to be placed in a nursing home. A patient who has experienced delirium is also at a higher risk of readmission to the hospital and of developing dementia.
How to Detect Delirium in a Loved One
While doctors and nurses at 麻豆学生精品版 know how to treat the numerous ailments of their patients, it is not always easy for them to notice a change in a patient鈥檚 thinking. Every patient has a baseline level of cognition鈥攈ow they normally behave every day, whether they鈥檙e sharp as a tack, have a generally introverted or extroverted personality, or suffer from dementia. This baseline isn鈥檛 always perfectly clear to the patient鈥檚 care team.
鈥淚t is so important for family to be involved in the patient鈥檚 care and be able to tell the care team what their baseline is,鈥 says , a clinical pharmacist at the University of Utah . 鈥淚f you see a change, bring it up. You know your loved one best.鈥
In addition to a sudden onset of confusion, a patient with delirium may experience a fluctuation of confusion鈥攆eeling confused at one moment, and then fine another. Delirium may impair a patient鈥檚 attention, causing him or her to be easily distracted or have trouble following a conversation.
Another easy way to detect delirium is if the patient is experiencing disorganized thinking, which can include strange conversations or flow of ideas, rambling, and even hallucinations and delusions. Delirium can be manifested in hyperactive or hypoactive behaviors鈥攜our loved one may become abnormally excited and aggressive or fall quiet and lethargic.
About 25% of patients over age 65 who come to the hospital are already delirious, according to Miriam Beattie, DNP, a nurse practitioner at 麻豆学生精品版. 鈥淒elirium is the reason their family members bring them to the hospital,鈥 she says. 鈥淚f you can discover what the underlying medical cause is and reverse or treat it, then the patient has a much better chance of recovery.鈥 However, there鈥檚 no approved medical treatment for delirium, so Beattie insists that prevention is key.
How to Prevent Delirium in a Loved One
Fortunately, delirium is easier to prevent than it is to detect. Prevention focuses on keeping the patient鈥檚 baseline at its normal level. There are many ways to maintain that level both in the hospital and at home, including:
- Making sure the patient uses proper eyeglasses and hearing devices at all times if needed.
- Orienting the patient to the day, time, place, weather, etc.
- Encouraging healthy sleep patterns and minimizing daytime napping.
- Keeping the patient physically active with range of motion exercises.
- Making sure the patient is eating regularly and staying hydrated.
- Avoiding high-risk medications.
There are certain medications that increase the risk of delirium, such as over-the-counter sleep aids like diphenhydramine (Benadryl or Tylenol PM). 鈥淢ake sure that patients are always talking to their pharmacists or providers, asking if the medication is okay,鈥 Hansen says.
Awareness and prevention of delirium will make a significant impact on your loved one鈥檚 continuing health. Simple tasks like remembering to put on eyeglasses before getting out of bed or going for a brief walk can make a world of difference.