As we age, changes in health and cognitive function become increasingly common, and for some older adults, this includes the onset of a condition known as delirium.
While often confused with dementia, delirium is a distinct and potentially reversible condition. Understanding delirium and how to respond to it is crucial for carers and family members.
What is Delirium?
Delirium is a sudden and severe disturbance in mental abilities that causes confusion and reduced awareness of the environment. It typically develops over hours or days and is often temporary, although it can persist if untreated.
Delirium occurs due to a disruption in the normal functioning of the brain, which may result from an underlying medical condition, medication side effects, or a combination of factors. Older adults are particularly vulnerable to delirium because of age-related changes in the brain, existing health conditions, or hospitalisation.
It is important to distinguish delirium from dementia. While both conditions involve cognitive impairment, dementia is a gradual and progressive decline, whereas delirium is acute, fluctuates in severity, and can often be treated or reversed.
Symptoms of Delirium
Delirium presents in various ways and can be categorised into three types:
Hyperactive delirium: This is characterised by restlessness, agitation, mood swings, and sometimes hallucinations or delusions.
Hypoactive delirium: This type involves lethargy, reduced alertness, sluggishness, and withdrawal. It is often mistaken for depression.
Mixed delirium: This involves symptoms of both hyperactive and hypoactive delirium, with fluctuations between the two.
Common symptoms include:
- Sudden confusion or disorientation
- Difficulty focusing or maintaining attention
- Changes in perception, such as hallucinations or seeing things that aren't there
- Disturbed sleep patterns or reversal of day-night cycles
- Mood changes, such as irritability, anxiety, or apathy
- Difficulty speaking or recalling words
- Memory problems, especially with recent events
These symptoms can vary throughout the day, with periods of lucidity followed by episodes of confusion.
Causes and Risk Factors
Delirium is usually triggered by an underlying condition or combination of factors. Common causes include:
Infections: Urinary tract infections, pneumonia, or sepsis.
Medication: Side effects, interactions, or withdrawal from sedatives or painkillers.
Dehydration or malnutrition: Inadequate fluid or nutrient intake.
Electrolyte imbalances: Such as low sodium or calcium levels.
Pain or discomfort: Often unexpressed or unnoticed in non-verbal patients.
Hospitalisation or surgery: The unfamiliar environment and anaesthesia can be disorienting.
Chronic illnesses: Such as heart failure or chronic obstructive pulmonary disease (COPD).
Sensory impairments: Poor eyesight or hearing can exacerbate confusion.
Treating Delirium
Treating delirium involves identifying and addressing its underlying causes. A thorough medical assessment is essential, which may include blood tests, imaging studies, and a review of medications.
Treatment strategies include:
Resolving underlying conditions: Treating infections, balancing electrolytes, or adjusting medications can significantly improve symptoms.
Environmental modifications: Ensuring a calm, well-lit, and familiar setting can help reduce disorientation.
Medication: In some cases, medications such as antipsychotics may be used to manage severe agitation or hallucinations. However, these are typically a last resort due to potential side effects in older adults.
Prompt treatment is crucial to prevent long-term complications or a decline in health.
How to Support Someone with Delirium:
If a loved one or patient is experiencing delirium, your support can play a critical role in their recovery. Here are ways to help:
Create a reassuring environment
Keep the surroundings familiar and comforting.
Use clocks, calendars, and photographs to orient them to time and place.
Reduce noise and minimise sudden changes in their environment.
Communicate clearly
Speak slowly, calmly, and in short sentences.
Reassure them of their safety and avoid arguments.
Gently correct any misunderstandings, such as misperceptions or delusions, without being dismissive.
Encourage regular routines
Maintain regular sleep and mealtimes to restore a sense of normalcy.
Encourage light physical activity, such as short walks, if appropriate.
Monitor hydration and nutrition
Offer water and nutritious meals regularly.
Watch for signs of dehydration, such as dark urine or dry skin.
Engage them in meaningful activities
Offer simple tasks they enjoy, like listening to music, drawing, or reminiscing.
Gentle stimulation can help reduce feelings of isolation and improve focus.
Involve healthcare professionals
Report any changes in their condition to their doctor.
Ensure follow-up care to address potential lingering effects.
Preventing Delirium
While not all cases of delirium can be prevented, certain measures can lower the risk:
Regular health check-ups: Early detection of infections or chronic conditions.
Medication reviews: Ensuring that prescriptions are appropriate and avoiding unnecessary medications.
Hydration and nutrition: Encouraging a balanced diet and adequate fluid intake.
Maintaining sensory aids: Properly functioning glasses and hearing aids.
Physical activity: Promoting regular exercise to improve overall health.
Delirium is a serious but often treatable condition that can significantly impact the well-being of the elderly and their families. By understanding the symptoms, seeking prompt medical care, and providing supportive environments, you can make a meaningful difference in the recovery process.
If you’re caring for someone with delirium, remember to look after your own well-being as well. Supporting someone through confusion and distress can be challenging, and seeking advice or respite care when needed is vital for both you and your loved one.
Delirium may be disorienting, but with the right care and understanding, it doesn’t have to mean permanent decline.