Managing Delirium in Older Adults

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Delirium is a sudden change in mental status that may occur in older adults at any time but especially during hospitalizations, after surgery, or anytime the environment around them changes.  Other factors that may contribute to delirium include acute illness such as an infection and medications.  Unfortunately, the symptoms of delirium may be confused with early dementia and dismissed.  Remember that dementia is typically a slowly progressive disease while delirium almost always has an acute onset and resolves when the cause is identified and removed.

Some common symptoms of delirium include

  1. Confusion
  2. Frequent mood swings
  3. Memory loss, including forgetting recent events or family members names
  4. Sudden changes in personality or emotional state
  5. Decreased attention or concentration
  6. Periods of alertness that come and go throughout the day
  7. Hallucinations (seeing or hearing things that are not there)
  8. Insomnia and changes in usual sleep patterns
  9. Slower movements or unusually restless movements
  10. Changes in speech, such as saying things that don’t make sense

Reversible Causes of Delirium

  • Starting new medications or changing current medication doses
  • Stopping medications that the person has been on for a long time
  • Stopping abruptly the regular use of alcohol or sleeping pills
  • Pain that is not being treated well
  • Constipation
  • Thyroid problems
  • Infections, especially of the lungs or urinary tract
  • Not getting enough liquids (dehydration)
  • Stroke
  • Heart problems, including heart failure and irregular heart rhythms

Caregiving Tips for Delirium in Older Adults

  • Watch for changes in behavior or alertness
  • Stay with the older person as much as possible
  • Make sure they have eyeglasses, hearing aids, and dentures readily available
  • Gently and calmly explain any changes in environment such as ER visit or hospitalization
  • Make the new environment feel more familiar by bringing in familiar objects
  • Encourage physical activity, games, and conversation
  • Share  a list of health problems (diagnoses) and current medications with all health care providers