Caring for an Older Adult? How to Detect Delirium in Your Loved One, and What You Can Do

SBM: caring-for-an-older-adult-how-to-detect-delirium-in-your-loved-one-and-what-you-can-do

Heather Derry, PhD, Postdoctoral fellow, Weill Cornell Medicine

Amy Shaw, MD, Assistant Professor of Clinical Medicine, Weill Cornell Medicine

Because the body and mind are connected, changes in a person’s thinking -- also known as “mental status” or “cognition” -- can often signal that a physical problem needs to be addressed. This is especially true for older adults, who are at increased risk for a condition called delirium.

What is Delirium?

Delirium is a sudden change in a person’s thinking and attention, leading them to become confused.

Older Adults and Delirium

Episodes of delirium are common among older adults, especially those who are ill, recovering from surgery, or in the hospital.

Delirium is different from dementia, where changes in cognition happen more slowly over the course of months and years; however, having dementia can increase the risk for delirium.

Importantly, delirium indicates that there may be an urgent medical problem that should be evaluated by a medical provider. For example, delirium can be caused by an infection, certain medications, problems with how a person’s organs are working, or other health problems. Most of the time, there are multiple reasons that delirium occurs, and the conditions can be resolved. However, delirium is frequently overlooked -- many people are not aware of the symptoms, and the symptoms can mimic other conditions (such as depression).

After someone becomes delirious, it can take weeks or months for him or her to get back to their usual level of cognitive function. For others, cognitive problems can persist in the long-term. Researchers are working to understand how certain factors, such as a person’s pre-existing cognition or changes in the brain, might be linked with different patterns of recovery.

How to Detect Delirium in Older Adults

As a family member and/or caregiver of an older adult, you are an important part of your loved one’s healthcare team. Because you know and spend time with your loved one (typically, more than nurses or physicians can!), you are in a good position to notice signs of delirium if they occur.

Symptoms of delirium arise quickly, over the course of hours to days. It is common for these symptoms to fluctuate between mild to severe, which can make it challenging to know when to seek treatment. These are signs to look out for:

  • Changes in attention: The person may not be able to concentrate on conversations, reading, TV, or other things that they normally follow.
  • Changes in orientation: The person may not know where they are, what day it is, or what time of day it is.
  • Changes in thought process: The person may ramble, or say things that do not make sense to you.
  • Changes in perception: The person may see or hear things that are not there.
  • Changes in behavior: The person may become unusually agitated, have slowed movements, or act quiet or withdrawn.
  • Changes in emotions: The person may become easily upset or very emotional, in ways that are out of character.
  • Changes in sleeping and alertness: The person may become overly drowsy and sleepy during the day, or stay awake at night.

What to Do if You Detect Delirium

If you notice these changes in your loved one, it is important to tell a nurse or physician as soon as possible. Here are a few tips for the conversation:

  • Be as specific you can. What did you notice that made you concerned?
  • Highlight what is different from how your loved one normally acts.
  • Ask about delirium, such as “I’m worried he might be delirious. What do you think?”
  • Ask for tips about how to respond to your loved one’s behavior.

It can be scary to observe these changes in a loved one – knowing how to respond can help you to feel more equipped to deal with the situation.

Preventing Delirium

Research also shows that there are effective ways to prevent delirium before it happens. If you are caring for an older adult who is ill, hospitalized, or recovering from surgery, we encourage you to discuss this with his or her medical provider. Here are a few healthy behavior strategies that can reduce the likelihood of delirium in older adults:

  • Conversation: Having regular visits or discussions about interesting topics can be useful for keeping their thinking on track. Help to keep your loved one oriented to the time of day.
  • Sunlight: If possible, open the curtains in the room to allow light to enter, which can help to signal the time of day.
  • Movement: When it is medically safe, encourage your loved one to walk or move regularly (for example, after surgery), using a cane or walker if necessary.
  • Hearing and vision aids: Remind him or her to use hearing aids and glasses when needed.
  • Nutrition: Help your loved one stick to the eating and drinking plan that is recommended by the medical team. Let the medical team know if he or she develops constipation or other problems.
  • Nighttime sleep: Establish a calming bedtime routine, and try to avoid waking him or her up at night when possible. If your loved one is in a new environment like a hospital, try to make him or her more comfortable by bringing familiar items from home, such as a favorite blanket or book.

In summary, delirium is common in ill or hospitalized older adults. It is often overlooked, but noticing these symptoms can help to give important information about physical problems that may need treatment. If you notice delirium in your loved one, tell his or her healthcare providers. With the knowledge of how to prevent and detect delirium, you can play a key role in helping the healthcare team notice when something’s “off” with your loved one’s health.

Want to learn more? Check out these resources:

https://deliriumnetwork.org/blog/

https://www.hospitalelderlifeprogram.org/for-family-members/

https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386

https://www.icudelirium.org/patients-and-families/overview

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References:

− Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K. (2017). Delirium in older persons: advances in diagnosis and treatment. JAMA, 318(12), 1161-1174.

− Inouye, S. K., Bogardus Jr, S. T., Charpentier, P. A., Leo-Summers, L., Acampora, D., Holford, T. R., & Cooney Jr, L. M. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340(9), 669-676.

− Hshieh, T.T., Saczynski, J., Gou, R.Y., Marcantonio, E., Jones, R.N., Schmitt, E., Cooper, Z., Ayres, D., Wright, J., Travison, T.G. and Inouye, S.K. (2017). Trajectory of functional recovery after postoperative delirium in elective surgery. Annals of Surgery, 265(4), p.647.

− Rosenbloom-Brunton, D. A., Henneman, E. A., & Inouye, S. K. (2010). Feasibility of Family Participation in a Delirium Prevention Program For The Older Hospitalized Adult. Journal of Gerontological Nursing, 36(9), 22.


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