Archive for March 23rd, 2010

Posted on March 23, 2010 - by Nurse Virginia

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

(Part II)

Delirium is a medical emergency pointing to an abnormal physical condition or response.  It is characterized by the sudden onset and rapid fluctuations in change of mental status.  It may be a response to:

• An infection – post surgery, urinary, urinary or bowel retention
• A head injury/trauma – fall
• Elevated temperature
• Metabolic problem – highest incident – 20-40% of cases of delirium result from a organ failure (liver, kidney) diabetes, hyperthyroidism, hypothyroidism
• Medications – antipsychotics, sedatives, anti-inflammatory, antihistamines, anti-depressants ( most common cause of reversible delirium)
• Acute vascular incident
• Alcohol withdrawal

While there are many possible causes of delirium. What is known is that the elderly population not only experiences the highest incident of delirium, but also the poorest outcomes. Studies indicate that around 50% of the elderly transferred from a hospital setting to a nursing home setting are suffering from delirium.

The hospital tells the family that they must discharge the elder, and the family thinks how can we possibly take care of Dad at home, he is so confused. So the elder may go prematurely to a nursing home, only to have the staff there begin to medicate him for the various behaviors they witness. This can create an added burden on the already confused elder suffering from delirium.

There is no simple test for delirium

Dementia is not an illness, but rather a group of symptoms associated with an illness. Likewise delirium is not an illness itself, but also a group of symptoms associated with the illness. The symptoms of dementia are very much like the symptoms of delirium.

• Memory loss
• Hallucinations (only visual – hearing voices would not indicate delirium)
• Highly distracted
• Confused thinking
• Disoriented to time, date and place
• Not capable of new learning – will ask the same questions over and over – not retaining the answers

However the elderly suffering from delirium will have newly acquired language difficulties. Less coherent communication skills as well as be less able to name objects correctly and suffer from a decrease in writing skills.

The family – very important part of the health-care team

The family is there to communicate the elder’s history. Even, if you find yourself telling the same story over and over to everyone who comes into the elder’s room. It is of most importance that the health-care team knows that this is a sudden change in condition. And also what is normal for this elder.

The family member is there to provide support, as I needed to do for my Dad when he experienced bouts of delirium. The elder needs a supportive presence to provide repeated orientation cues. Monitor the environment to reduce distractions (especially when the elder is in the hospital). Use clear language, avoiding pronouns while introducing staff to the elder by their name. The elder needs explanation and reassurance until their normal level of function returns.

See also Blogs: Auguste Deter, First Person Diagnosed with Alzheimer’s Disease

(January 3, 2010)

What is Dementia? Reversible Dementia, Irreversible Dementia, Vascular Dementia and Alzheimer’s Disease?      (December 17, 2009)

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