Archive for March 22nd, 2010

Posted on March 22, 2010 - by Nurse Virginia

WHEN THE ELDERLY HAVE A SUDDEN ONSET OF CONFUSION IS IT DEMENTIA OR DELIRIUM?

(Part I)
“Dad’s in the hospital.” Those words, for the last ten years of his life, would get me moving. But first I would call the hospital and ask for his nurse. I would explain that my Dad had a history of delirium when hospitalized and that I was on my way and would stay with him. But most of all “Don’t medicate him for any behaviors.”

Many elderly hospital patients develop delirium while hospitalized or are admitted due to delirium. Because delirium can look so similar to dementia the family is a very important member of the care team. The family knows what is “normal” for the elder. When did they start to see changes? The key here is how fast the changes in behavior, memory loss, hallucinations came about. With dementia it is a slow process, over months/years. With the elderly and delirium, it is a sudden and noticeable change.

The reassuring presence
When I arrived at the hospital I would immediately station myself directly in front of Dad. Close enough to make very good direct eye contact. Then I let nurses and tech people walk around me. I smiled at Dad; spoke in a reassuring way no matter what he would be telling me. It usually had something to do with snakes on the wall. He would be highly distracted, by what he was hallucinating at the moment and it was necessary to maintain that close connection to reality. We kept the curtains open and when it got dark – had all the lights on in the room to decrease the chance of shadows.

After awhile Dad would start to say that he knew there weren’t things crawling on the walls, but he could still see them. When a nurse came in to check an IV or wound (delirium is very common in the elderly after surgery) I would introduce myself and Dad.  I would call the staff member by name and create a friendly connection between Dad and his caregivers.

I would always talk about Dad’s condition to the staff, in the room, in front of him to avoid any chance of creating feelings of suspicion in him. I would explain that Dad was having some problems with confusion just now, but that this wasn’t normal for him. All the while I would be talking to them, but maintain that eye contact with him, and continue to smiling.

Change in condition
The consistent message I had for the hospital staff was, “This is not normal for Dad.”   The elder’s normal level of orientation is so important. If the family member is not there the staff might medicate an agitated elder or worse restrain them. On one such occasion, when I arrived Dad was sitting at the nurses station with a vest restraint on, tied to a wheelchair. He had kept trying to get out of bed and the staff was afraid he would fall.
Dad never forgot the indignity of being tied. For many months after the hospitalization he would refer to how I saved him when I came and untied him. He wouldn’t really remember my sitting there with him, but he sure remembered that release from restraints.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com