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Delirium is a temporary but serious condition that causes sudden confusion, emotional disturbances, and unusual behavior. When it occurs in a hospital setting, such as the emergency department (ED) or the intensive care unit (ICU), it is known as hospital-acquired or hospital-induced delirium. Hospital delirium is common in older adults. This article explores what caregivers need to know to help someone at risk of hospital delirium. Delirium affects a person’s mental state, along with their attention, consciousness, perceptions, and reasoning. The symptoms can vary a lot from one person to the next. They may also differ from one episode to the next, or evolve over the course of a single episode. Some common symptoms of delirium are outlined below. Disturbances in attentionA person with delirium might find it difficult to focus their attention. They might have trouble answering questions or shifting topics, or they might get distracted easily. Disturbances in awarenessDelirium can affect how responsive a person is to their environment. Some people with delirium appear withdrawn or indifferent. Others experience agitation, paranoia, or hallucinations. Disturbances in cognitionCognition refers to thought processes. Delirium can cause confusion and disorientation. It can also cause challenges with memory, speech, or other everyday activities such as walking, reading, or eating. Other symptomsSome other symptoms of delirium include:
If you’re caring for someone with another condition that affects their mental state, such as dementia, it might be harder to identify signs of hospital delirium. A key difference is that delirium comes on suddenly, while dementia develops gradually. Consult their doctor to learn more about potential warning signs. To treat hospital delirium, doctors will first try to address the underlying cause. What causes delirium can vary from one person to the next. A doctor will suggest treatments based on contributing factors. In the case of an infection, for example, a doctor would prescribe antibiotics. Supportive care can make the person more comfortable and prevent further complications. Supportive care might involve avoiding or adapting usual treatment strategies. Examples include not using physical restraints or urinary catheters. Sometimes, a doctor may prescribe medication to alleviate symptoms, such as agitation, restlessness, paranoia, or hallucinations. If you suspect a loved one is delirious, express your concerns to medical staff as soon as possible. Remember that you know your loved one best. You can try to gently redirect your loved one by asking them to look out the window at the weather or talking about recent events. Take the time to explain why they’re in the hospital. If they don’t respond, aim to be a comforting physical presence. It will likely be distressing to see your loved one in this state. Their words and actions might not align with the person you know. They might become angry at you or forget who you are. It’s not your fault. Try to remain calm and accept your own emotions. It’s typical to feel fear, frustration, embarrassment, sadness, or guilt in this situation. If you’re struggling, ask to speak with a hospital social worker, chaplain, or counselor. There’s no single cause of hospital delirium. Some people may experience one or several triggers in a hospital setting. For others, there’s no identifiable cause. Potential causes of hospital delirium include:
Some people are at an increased risk of experiencing hospital-induced delirium. These include people who:
The conditions of someone’s hospital stay may also increase their risk. Rates of hospital-induced delirium are higher for people in ICU or on mechanical ventilation. Researchers estimate that almost 40% of cases of hospital delirium are preventable. There’s much that hospital staff can do to help prevent delirium. But caregivers can also play an important role. Role of hospital staffThere are models that enable healthcare professionals to predict the chances of delirium in a patient. These models consider and weigh various risk factors. Results may suggest whether doctors should take preventive measures. Environmental factors can play a role in the development of delirium. Hospital staff can help create an environment that can reduce the risk. They may consider the following:
A doctor may consider medication to help prevent delirium. A 2016 clinical trial suggests that the drug dexmedetomidine might lower the risk of delirium in patients on ventilators. Other research from 2016 found a link between melatonin and lower rates of hospital delirium in older adults, but recent trials did not support the link. Some medications that doctors commonly prescribe in the ICU are linked to a higher risk of delirium. If someone may be at high risk for delirium, doctors may consider avoiding these medications. Examples include:
Role of caregiversPreventing hospital delirium can be a challenge for caregivers. Certain aspects of the hospital environment and the care provided are beyond your control. There are still ways in which you can help your loved one:
Know that, as a familiar presence in an unfamiliar setting, you’re already reducing your loved one’s risk of hospital delirium. Recovery time typically depends on the person’s health before the episode. Most people can regain their regular abilities within a period of weeks or months. But those with serious health conditions, such as dementia, might never fully recover. Can COVID-19 cause hospital delirium?Yes, COVID-19 has been linked to hospital delirium. A 2020 study of 852 people admitted to a hospital for COVID-19 found that 11% developed delirium over the course of their stay. A 2022 study of 927 older adults admitted to the hospital for COVID-19 found that about one-third developed delirium during their stay. The above study was conducted in the early months of the pandemic, but more recent studies have shown that delirium is still common in older adults who are hospitalized for COVID-19. Can hospital delirium lead to death?Hospital delirium is associated with an increased risk of death. In the 2019 study cited above, delirium in older adults was linked to a greater risk of dying in the hospital. And according to 2022 research, ICU delirium is associated with a two- to four-times increase in the overall risk of death. Hospital-induced delirium is a condition that causes disruptions in awareness, attention, and cognition. It develops suddenly and may last for several hours or days. As a caregiver, you know your loved one best. While it’s not always possible to prevent delirium, you can aim to be a supportive and familiar presence in a hospital setting. Ask your loved one’s doctor what you can do to support your loved one following an episode of delirium. Chat with your loved one, help them move around, and ensure they’re comfortable. Promote healthy habits by ensuring they get enough food, liquids, and rest.
This information will help you learn about delirium. It will also help you care for a friend or family member with delirium. Back to topAbout DeliriumDelirium is a sudden change in the way a person thinks and acts. People with delirium can’t pay attention to what’s going on around them, and their thinking isn’t organized. This can be scary for the person with delirium, their family, caregivers, and friends. Delirium can start in a few hours or over several days. The symptoms can come and go. Most of the time, delirium is caused by an illness or injury. Delirium isn’t the same as dementia. Dementia is a state of confusion that slowly gets worse over time and won’t get better. Delirium happens suddenly and usually gets better with treatment. Back to topSigns of DeliriumSomeone with delirium may have 1 or more of these signs. They may:
Call the person’s doctor or nurse right away if they seem confused or show any signs of delirium. Back to topCauses of DeliriumDifferent things can cause delirium. Some common causes are:
Risk factors for deliriumSome things can put a person at a higher risk of getting delirium. A person may be at risk for delirium if they:
Treatment for DeliriumThe best way to treat delirium is to find and treat the thing that’s causing it. Sometimes, many tests are needed to find the cause. These tests can include blood tests, x-rays, brain imaging (such as MRI’s and CT scans), and electrocardiograms (EKGs). The person’s doctor or nurse will also ask questions about their medical history such as past illnesses, treatments, and other things about their health. Once the cause of the delirium is found, treatment can start. If the person is upset or nervous, they may be given medication to help them relax. Medical equipment that isn’t needed will be taken out of their room to help them feel safer. Some people will also have someone in their room to make sure they’re safe such as a nursing assistant. Back to topHow to Help a Person with DeliriumThere are many ways you can help a person with delirium. You can help them by:
Recovering from DeliriumDelirium can last from a day to sometimes months. If the person’s medical problems get better, they may be able to go home before their delirium goes away. Some people’s delirium symptoms get much better when they go home. Other people might keep having memory issues and forget the date and where they are for months after the cause of their delirium is treated. Their doctor, nurse, social worker, and case manager will help you plan for their care at home. Call their doctor or nurse if you have any questions or concerns. Back to top |