Identifying Delirium: Common Causes and Treatment Options
Having to stay in a hospital or long-term care facility is stressful. Not only is a patient sick or injured, but they are in an unfamiliar environment away from their families and may not know the health care professionals they see each day. Up to of older adults staying in the hospital can develop a condition called delirium. It is especially common in people age 65 and older.
What is delirium?
鈥淒elirium is like an acute brain failure,鈥 says Chelsee Marshall, BSN, RN, a nurse specialist in the Hospital Elder Life Program (HELP) at 91麻豆天美直播. 鈥淎 lot of times it happens in the hospital, but it鈥檚 also associated with underlying issues that can cause hospitalization, so it鈥檚 definitely a reason to seek emergent care.鈥
Since delirium is a cognitive issue that involves a person becoming confused about their surroundings and primarily affects older adults, people might mistake it for dementia. While someone can have delirium and dementia at the same time, they are two different syndromes with important distinctions. While delirium symptoms appear over hours or days, dementia can take years to become noticeable. Delirium symptoms can improve, while dementia patients experience a decline that is not reversible.
What Causes Delirium?
Even though older adults are most at risk, several factors can cause delirium for a person of any age, including:
- Dementia or other cognitive disorders
- Having had delirium in the past
- Serious infections like pneumonia or sepsis
- Organ failure
- Not having access to eyeglasses or hearing aids
- Substance use disorders
- Nutrition issues such as vitamin deficiencies or electrolyte imbalances
- Dehydration
- Extreme psychological stress
- Sleep disorders or significant lack of sleep
- Undergoing anesthesia
- Some medications
- Lack of socialization
- Admission to the Intensive Care Unit (ICU)
鈥淭here are so many different things that can cause delirium, and often it鈥檚 a perfect storm of multiple causes,鈥 says Roxanne Weiss, MD, a geriatrician and medical director of HELP at 91麻豆天美直播. 鈥淭hat鈥檚 why it鈥檚 important to understand the gravity of delirium and why it鈥檚 considered an emergency, because we need to get to the bottom of what鈥檚 causing it.鈥
How is Delirium Identified?
Whether in the hospital or at home, the most common signs of delirium for people are:
- Confusion about where they are or what day it is
- Being unable to concentrate
- Disorganized thinking
- Memory issues
- Being unaware of their surroundings
- Feeling fear, sadness, or anger
Along with these general symptoms, a person may show signs of either hypoactive or hyperactive delirium.
Hypoactive Delirium
Hypoactive delirium involves a noticeable dip in a person鈥檚 activity levels and can be harder for a health care provider to diagnose, as it can seem like depression or fatigue.
However, the following symptoms may stand out to loved ones of the person experiencing delirium:
- Lethargy, fatigue, or drowsiness
- Apathy about their usual activities
- A slower response time
- Decrease in speech
- Physical inactivity
鈥淗ypoactive delirium is much more challenging for a health care provider to detect because oftentimes the patient will just seem sleepy or less responsive, and we don鈥檛 know what that person is normally like at home,鈥 Weiss says. 鈥淭hat鈥檚 when it鈥檚 really important for a family member to convey very clearly to the medical team that this is not how their loved one normally is, and they鈥檙e concerned about delirium.鈥
Hyperactive Delirium
Conversely, hyperactive delirium involves an increase in activity and the following symptoms:
- Pacing
- Agitation
- Combative behavior, such as trying to remove their IV
- Mood swings
- Insomnia
- Hallucinations or delusions
- Hypervigilance
Mixed Delirium
Some people may even exhibit mixed symptoms, meaning they may have signs of hypoactive delirium and then switch to having symptoms of hyperactive delirium, or vice versa. This can happen from day to day, or even over the course of a few hours.
How Is Delirium Treated?
Most cases of delirium resolve in a few days. However, some cases may only last a few hours, while others can last weeks or months. Recovery times are typically shorter when the underlying causes are adequately cared for, which is why prompt medical attention is so important.
If your loved one starts exhibiting delirium symptoms at home, it鈥檚 important to consult their doctor right away to determine next steps. Contact their primary care provider immediately or take them to an urgent care center. It鈥檚 important to see a medical professional as soon as possible to determine the underlying causes and promptly start a treatment plan.
鈥淢any patients will recover from delirium and be fine, but there are times when people have lasting cognitive impairment,鈥 Marshall says. 鈥淲e don鈥檛 have a magic pill to treat delirium, but we can make sure we鈥檙e addressing their modifiable risk factors, like treating any infections, making sure they鈥檙e hydrated and eating, and making sure they鈥檙e getting up and moving around. The risk factors are the things that we can control and do something about.鈥
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