When an older adult suddenly exhibits confused behavior, loved ones may fear that he or she is experiencing the onset of dementia. Such fear may be unwarranted, however. The cause of the senior’s behavior might well be delirium.
Delirium, says the Alzheimer’s Association (AA), is a “medical condition that results in confusion and other disruptions in thinking and behavior, including changes in perception, attention, mood and activity level.” However, the AA stresses that delirium is not the same as dementia, even though “individuals living with dementia are highly susceptible to delirium.”
To help distinguish between the two conditions, the AA notes that in dementia, changes in memory and intellect emerge gradually over a course of months or years, while delirium comes on abruptly, over days or weeks, or even hours. In delirium, thought patterns become disorganized and the level of confusion can fluctuate dramatically. “The hallmark separating delirium from underlying dementia is inattention,” says the AA. “The individual simply cannot focus on one idea or task.”
Unlike most forms of dementia, including Alzheimer’s disease, delirium is usually reversible, and sometimes even preventable. According to the Mayo Clinic, the condition can occur “when the normal sending and receiving of signals in the brain become impaired.” The Mayo Clinic cites an extensive list of factors that can cause, or contribute to, the onset of delirium, especially among older adults. Those factors range from infections and alcohol withdrawal to dehydration, sleep deprivation, metabolic imbalance and emotional distress. In addition, many medications for common ailments, such as asthma, allergies, insomnia, Parkinson’s disease, chronic pain, and anxiety and depression, can trigger delirium.
Still another potential factor is hospitalization. The Harvard Medical School says delirium is the most common complication of being hospitalized among people 65 and older. Its occurrence is especially prevalent after the patient has had certain forms of surgery. The medical school points out that most cases of delirium in hospitals are of the “hypoactive” type, meaning the patient becomes withdrawn and lethargic (as opposed to “hyperactive,” which means agitated and possibly hallucinatory or belligerent). Since people with hypoactive delirium aren’t disruptive, their condition may not be diagnosed. This is important, says the Harvard doctors, because, “Recognizing delirium is critical to a successful outcome for older patients.” The quicker delirium is treated and resolved, the better the patient’s chances for a full “functional recovery.”
There are several steps a caregiver can take to help a hospitalized loved one recover quickly from delirium, or possibly even prevent its onset. The Vanderbilt University Medical Center’s ICU Delirium and Cognitive Impairment Study Group makes the following recommendations to help orient the patient:
- Speak softly and use simple words or phrases.
- Remind your loved one of the day and date.
- Talk about family and friends.
- Bring eyeglasses, hearing aids.
- Decorate the room with calendars, posters or family pictures. These familiar items might be reminders of home.
- Play his or her favorite music or TV shows.
- If your loved one has delirium, you might be asked to sit and help calm him or her.
In most cases, the delirium is short lived. It need not be related to dementia or result in permanent cognitive impairment. The important thing above all is to ensure that it is diagnosed and treated quickly.