Delirium in People with Dementia a Cause for Concern During Hospitalization

Dorian Martin Health Guide
  • Mom was hospitalized several times while living at the nursing home. She was sent to the hospital for issues related to her chronic obstructive pulmonary disease, but her stays were complicated by the fact that she had Alzheimer’s disease. And at times, she seemed to struggle with a bit of delirium during her last hospital stay.

    It turns out that hospital stays can be problematic for any patient who develops delirium. In fact, the Mayo Clinic pointed out that hospitals often can exacerbate delirium due to frequent room changes, loud noises, poor lighting and invasive procedures.

    However, developing the combination of dementia and delirium, which is known as delirium superimposed on dementia, while hospitalized is especially problematic. Researchers from Penn State University found that people who have dementia have a faster decline in both physical and mental health when medical professionals do not recognize and treat delirium during hospitalizations. This study involved 139 adults who were age 65 and older who had dementia. All of these adults had dementia.

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    While dementia is progressive and irreversible, delirium is a reversible cognitive condition. According to the Mayo Clinic, “delirium is a serious disturbance in a person’s mental abilities that results in a decreased awareness of one’s environment and confused thinking.” Delirium is often caused by infections, dehydration and changes in medication. If also can be traced to severe or chronic medical illnesses, surgery or substance abuse. The symptoms of delirium often fluctuate during the day so the patient may have periods where he or she exhibits no symptoms. The primary symptoms of delirium include:

    • Reduced awareness of the environment (wandering attention span, being easily distracted, being withdrawn, or getting stuck on an idea).
    • Cognitive impairment (poor memory of recent events, disorientation, difficulty speaking, rambling speech, difficulty understanding speech, difficulty reading or writing).
    • Behavior change (hallucinations, restlessness, agitation, disturbed sleep habits, and extreme emotions).

    Delirium often rapidly develops. However, if caught and treated early, the condition can be resolved. But that means hospital staff need to realize that this condition is present since its symptoms can be similar to dementia. There are some differences, though, as it relates to inattention, sleepiness and hyperactivity.

    The researchers found that approximately 33 percent of the study participants were dehydrated at the time they were admitted to the hospital. They also identified a 32-percent incidence of new delirium in the study participants during hospitalization. These participants remained in the hospital approximately four days longer than people who did not have delirium. Upon discharge, the study participants also had a lower level of physical and mental ability. That lower level of functioning was seen at follow-up visits with their physicians one month later. The researchers also found that patients who had delirium superimposed on dementia were more likely to die within the month after their hospital stay.

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    The researchers noted that previous studies have identified the cost of caring for someone with delirium in the hospital is similar to that of someone who has diabetes or heart disease. Their analysis found that shortening the length of the hospital stay of these people by just one day would result in more than $20 million in savings in annual health care costs.

    "Preventing delirium is important because we want to discharge patients at their baseline or improved functioning," said Dr. Donna Fick, distinguished professor of nursing at Penn State and the study’s lead investigator. "We do not want them to go home with worse functioning than when they came into the hospital."

    So is there a way to prevent delirium? The Mayo Clinic offered several suggestions, including:

    • Providing adequate amounts of fluid.
    • Using stimulating activities and familiar objects.
    • Encouraging the use of eyeglasses and hearing aids, if necessary.
    • Using simple and regular communication.
    • Using mobility and range-of-motion exercises.
    • Reducing noise and avoiding interrupting sleep.
    • Providing appropriate pain management.
    • Providing nondrug treatments for sleep issues or anxiety.

    So if you have a loved one with dementia who has to be hospitalized, be sure to talk to the hospital doctor or staff if you suspect delirium is setting in. Since you know your loved one's mental state out of the hospital, your feedback will be invaluable to the doctor.

    Primary Sources for This Sharepost:

    Indivero, V. M. (2013). Hospital study finds connection between dementia, delirium and declining health. Penn State.

    Mayo Clinic. (2012). Delirium.

Published On: September 23, 2013