Preventing Hospital Delirium in Elderly Patients

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A hospital stay is not, generally, a pleasant endeavor. For elderly people and their loved ones, any hospital stay carries a measure of anxiety and discomfort. Hospitalization typically comes after a surgery (which always carries risk) or an emergency situation. Even after successfully treating an emergency or carrying out a surgery, hospitals carry their own risk during recovery: hospital delirium.
Hospital delirium is simply a change in a patient’s mental state. It is typically accompanied by confusion, disorientation, and even hallucinations. The mental changes may make patients hyper-aware or suddenly unresponsive. While it usually goes away, especially if patients leave the hospital and return to their homes, a 2012 study done by Tsai, Weng et. al, which was published in General Hospital Psychiatry, warns that hospital delirium can contribute to premature death, particularly in patients over age 65.

Recognizing Hospital Delirium

Hospital delirium is a dysfunction of the brain that occurs quite frequently in older people who stay in the hospital, even for typical surgeries such as a hip replacement or knee surgery. The cause of delirium differs depending on the patient, but it is most commonly caused by medications (either adjustment from medications taken at home or the introduction of new ones during the hospital stay) and other actions by health workers, including immobilizing a patient. It develops in twenty percent of elderly patients staying in hospitals every year. As people age, the risks associated with hospital delirium become more serious—death is the most serious complication that can arise post hospital stay.
The symptoms typically begin with episodes of confusion or hallucination. One reporter at The New York Times reported that her mother complained at the hospital as if it were a hotel, asking for cocktails or trying to find a cleaner room. As delirium takes hold of a patient, the brain begins to fire off improper neurotransmitters; it may even cause long-term memory loss. This causes odd behavior, which can be aggressive, confused, or extremely lethargic.

How to Get Help

The best persons to recognize delirium are close family, friends, and/or caregivers of the elderly one in the hospital. Hospital workers often do not notice the small behaviors leading up to a serious event, but people who know a patient well can point out oddities that go beyond the effects of anesthesia or pain.
Many patients in intensive care or on life-supporting ventilators have trouble communicating because of tubes placed in their mouths. If a loved one is in such a situation, family members should be extra vigilant, since this raises the risk of the patient developing hospital delirium. Other means of communication–writing or asking simple “yes or no” questions–can help determine if the patient is in delirium or not. If caregivers notice signs of confusion and delirium, they should notify a doctor or nurse immediately.

The medical response to delirium should be swift. Family members and caregivers must not allow doctors or nurses (many of whom may be in the “old school” of treating delirium) to diminish concerns over a sudden change in behavior. Family members do well to make a plan immediately to change medications, shorten recovery time, and get the loved one up and about, all of which can help the delirium recede with few side effects.

Prevention

The first and most obvious way to prevent hospital delirium is to avoid hospital stays, especially those that last more than a few days. Fall prevention is a key way to avoid taking a loved one to a hospital for injury, and so is medication management for general health concerns such as diabetes. Talking with a loved one’s doctor about how to get home sooner or how to avoid hospital stays, given the loved one’s particular health concerns, will help family members plan for the shortest stays possible. Family members and caregivers should also seek to have their loved ones exercise, mentally and physically, during a hospital stay. Consultation with a doctor to find the best activities for the elderly loved one based upon his or her particular health needs is important so as not to exacerbate existing health concerns.

The second best prevention method is to have the mental and emotional health of the elderly loved one evaluated and maintained by a professional while staying in the hospital. By ensuring that the loved one is experiencing minimal stress and disruption to other routines, such as medication, social time, bathing, and eating, family members can help the elderly loved one’s brain to balance the challenges faced during a hospital stay.

In addition to consulting with professionals and making a plan, bringing the personal touch to a hospital stay can help stave off and also detect hospital delirium. Family members should bring photos, flowers, and familiar objects (such as quilts, books, religious items, or even hygiene products) to the hospital room. The presence of family members is desirable whenever possible, especially if delirium has developed. A loving family caregiver is far more likely than a doctor or nurse to recognize odd behavior in the loved one. What is more, the presence of caring family members lowers patients’ stress levels and allows for pleasant social time between hospital-related activities.

Sources

Harvard Women’s Health Watch. (March 18, 2016).When Patients Suddenly Become Confused. Harvard Health Publications, Harvard Medical School. Available at http://www.health.harvard.edu/staying-healthy/when-patients-suddenly-become-confused. Retrieved May 5, 2016.

Schatz, Carolyn. (November 16, 2011). The dangers of hospital delirium in older people. Harvard Health Publications, Harvard Medical School. Available at http://www.health.harvard.edu/blog/the-dangers-of-hospital-delirium-in-older-people-201111163810. Retrieved May 5, 2016.

Seliger, Susan. (November 2, 2011.) Another Hospital Hazard for the Elderly. The New York Times. Available at http://newoldage.blogs.nytimes.com/2011/11/02/another-hospital-hazard-for-the-elderly/?_r=0. Retrieved May 5, 2016.

Tsai, M.C., Weng, H.H., Chou, S.Y., Tsai, C.S., Hung, T.H., and Su, J.A. (January-February 2012). Three-year mortality of delirium among elderly inpatients in consultation-liaison service. General Hospital Psychiatry, 34(1): 66-71. Available at http://www.ncbi.nlm.nih.gov/pubmed/22055331. Retrieved May 5, 2016.

Witlox, J., Eurrelings, L.S., de Jonghe, J.S., Kalisvaart, K.J., Eikelenboom, P., and van Gool, W.A. (July 28, 2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA, 304(4): 443-51. Available at http://www.ncbi.nlm.nih.gov/pubmed/20664045. Retrieved May 5, 2016.

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