Delirium: Higher Mortality Rate and Risk of Dementia

Delirium is an acute condition that is often related to an infection, drug interactions or withdrawal from drugs or alcohol. Symptoms of delirium include confusion, memory loss, decreased ability to communicate, a change in alertness (either restless and agitated or lethargy) and a decrease in attention. While often reversible, delirium is not something that can be casually dismissed, especially when it develops in an older adult.

Multiple studies have researched the effects of delirium on people. These include:

According to a study published in the journal General Hospital Psychiatry, the presence of delirium for hospital patients in intensive care units is associated with longer hospital stays and a higher rate of death.
Another study demonstrated that delirium is connected with a greater likelihood of long term care (nursing home) placement.
A third study of more than 500 people published in the journal Brain found that the risk of developing dementia after experiencing delirium was significantly greater than for those who had not suffered from delirium. Delirium was also associated with an increase in the severity of dementia in this study.

So, Now What?

Know the Risk Factors for Delirium

Delirium affects approximately 33% of older adults who present to hospital emergency departments, yet some research estimates that less than half of delirium cases are recognized and treated (University of Arizona Medical School).

According to a review of several research studies, risk factors for delirium include a history of hypertension (high blood pressure), age, use of a mechanical ventilator, and a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score.

Be Able to Distinguish Between Delirium and Dementia, and to Recognize Delirium Superimposed on Dementia

Know the signs of delirium, how to distinguish between delirium and dementia, and how to recognize delirium in someone who already has dementia. Remember that someone who has dementia and is hospitalized is at risk to develop delirium.

Advocate for Your Loved One

If you see signs of delirium in your family member, clearly communicate to the medical staff that her behavior and level of confusion are not normal for her. They need to know that you are seeing a change from the usual.

If you are able, spend additional time with your loved one at the hospital. Your familiar presence might reduce anxiety and possibly decrease the need for medications that can be used to calm people or the use of physical restraints. While there are situations where these medications are helpful and effective, they also have the potential to interact with other medications and can cause lethargy and increased confusion at times.

Try Additional Non-Drug Approaches

Some possible interventions to try to prevent or reduce delirium include ensuring that eye glasses and hearing aids (if appropriate) are in place, using clocks and calendars to increase orientation, and encouraging adequate hydration and food intake.

_Sources:

_{Brain 135 (2012) 2809-2816. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. http://brain.oxfordjournals.org/content/135/9/2809.full?sid=4a215262-c27b-493e-8329-36fcab549826}

_{General Hospital Psychiatry 34 (2012) 639-646. Incidence, prevalence, risk factor and outcome of delirium in intensive care unit: a study from India. http://www.sciencedirect.com/science/article/pii/S0163834312002009}

_{General Hospital Psychiatry. 2014 May 17.pii: S0163-8343(14)00108-X. A meta-analysis of critically ill patients reveals several potential risk factors for delirium. http://www.ncbi.nlm.nih.gov/pubmed/24950918}

_{The University of Arizona Medical Center. November 17, 2013. Delirium. http://www.acponline.org/about_acp/chapters/az/13mtg/thienhaus.pdf}