Many people generally
understand what dementia looks like in older adults. Memory loss, mobility issues, and a generally
slow, progressive process of losing the ability to interact with their
world. However, many people do not know
what delirium is, and fewer still know what it looks like. Why the comparison between the two? Delirium can sometimes be misinterpreted as dementia
and may be overlooked as the cause of a cognitive change.
Delirium has
gone through several name changes since it was first identified. You may have heard the terms acute confusion
state, toxic psychosis, reversible dementia, metabolic encephalopathy, or the
most common, confusion (Touhy & Jett, 2020). So now that we know what it’s called, what is
delirium? Delirium can manifest as a
disturbance to cognition, perception, attention, memory, mood, and sleep (Chen
et al., 2021). Delirium can look eerily like dementia, with the distinction
that the onset is sudden (Touhy & Jett, 2020). The noticeable change generally occurs over hours,
days, or even weeks (Touhy & Jett, 2020). Conversely, dementia typically
takes months to years to progress through well-identified stages.
Delirium can
be classified into two subtypes. They
are hyperactive and hypoactive. You may
see signs of one or the other type or both mixed (Touhy & Jett, 2020).
Below are a
few signs you may see with each type of delirium (Touhy & Jett, 2020).
Hypoactive
- Lethargy
- Withdrawn or sluggish
- Pleasantly confused
Hyperactive
- Yelling or calling out
- Aggressive or agitated actions
- Loud of fast speech
- Hallucinations or delusions
What causes
delirium? Many different factors can
cause delirium. A diagnosis of dementia or
depression increases the likelihood of a person experiencing delirium (Carey et
al., 2022). Additionally, medications or
medication changes, environmental changes (such as moving to a new house or
being admitted to the hospital), pain, dehydration, constipation, a recent surgical
procedure, or suffering from multiple chronic conditions such as diabetes,
heart disease, and kidney failure can all contribute to delirium (Carey et al.,
2022).
What do you
do when you suspect an older adult is suffering from delirium? Delirium is always a medical emergency and
should be treated as such (Touhy & Jett, 2020). Call your local emergency contact number and
let the operator know what changes you have noticed and when the changes started.
Due to the
unclear nature of the source of delirium, prevention can be challenging, but it
is not impossible. Prevention starts by
talking to your doctor about risk factors, including chronic conditions, your
medication regimen, your lifestyle, and the use of drugs or alcohol. Keeping a consistent sleep schedule, staying
hydrated, and keeping active can also help prevent delirium (Touhy & Jett,
2020).
Below are national organizations that offer a wealth of resources to those seeking
more information on delirium, its causes, and how to cope when a loved one is suffering
from delirium.
https://americandeliriumsociety.org/
- The American Delirium Society has an entire section of its website dedicated
to offering information and resources to patients and families that are dealing
with delirium.
https://ufhealth.org/research-study/ctsi-learning-health-system-initiative-inpatient-delirium-risk-identification-and
- The University of Florida in Gainesville, Florida, has a teaching hospital leading
a current research study looking at the relationship between hip fractures and
delirium in older adults. Information on
how to join the study is listed on the linked page.
https://www.icudelirium.org/medical-professionals/downloads/resources-by-category - This website offers several assessment toolkits for nurses. There are category-specific assessments, including post-surgical, pediatrics, and the intensive care unit.
Osmosis. (2016). Delirium - Causes, symptoms, diagnosis, treatment, and pathology [Video]. YouTube. https://www.youtube.com/watch?v=qmMYsVaZ0zoThis video offers an easy-to-follow overview of delirium, including causes, symptoms, and treatment of delirium.
References
Carey, E.,
Furlong, E., & Smith, R. (2022). The management of delirium in the older
adult in advanced nursing practice. British Journal of Nursing, 31(2),
76–84. https://doi.org/10.12968/bjon.2022.31.2.76
Chen, Y-R., Chen, Y-L., Chen, W-Y., Lin, Y-C., & Jane, S-W. (2021). Evidence-based nursing care of older adult patient with postoperative delirium and hip fracture. Journal of Nursing, 68(1), 90–96. https://doi.org/10.6224/JN.202102_68(1).12
Delirium.
(2022). Delirium: What role does it play in criminal cases? [Photo]. https://godoymedical.net/delirium/
Osmosis. (2016). Delirium - Causes, symptoms, diagnosis, treatment, and pathology [Video]. YouTube. https://www.youtube.com/watch?v=qmMYsVaZ0zo
Touhy, T.A.,
& Jett, K. (2020). Ebersole & Hess' Toward healthy aging: Human
needs and nursing responses (10th ed.). Elsevier.
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