Could Delirium Happen To ME? OR Someone I LOVE?

 Has my husband gone crazy? He keeps telling me he had lunch with his mother, but she passed away 10 years ago. One minute, he is talking to me, and the next moment, he is sound asleep. He came into the hospital for a hip replacement, and now I feel like I am talking to a completely different person. Can someone PLEASE tell me what is going on? 

Have you ever experienced this – or had a friend call you in a panic saying something similar to this? It is very possible that the spouse in this situation was suffering from delirium. 

Delirium is sometimes also called acute confusional syndrome and is often underdiagnosed in the hospital setting (Cano‐Escalera et al., 2021). The confusion is often sudden, may get worse at night, may affect their ability to stay alert or pay attention, can cause disruptions in their orientation (they don’t know who or where they are), may affect their speech or even their facial expressions (Touhy & Jett, 2019). Delirium is considered the second most prevalent and also preventable psychiatric issue is seen in the hospital setting (Cano‐Escalera et al., 2021).

What causes delirium? Funny, you should ask that; it might be easier to describe what doesn’t cause it! In the hospital setting things like increased anxiety, infection, sleep deprivation, metabolic changes, use of certain psychoactive drugs as well as organic system failure can all lead to delirium presenting itself, especially in the older patient (Cano‐Escalera et al., 2021). Sadly, we have been dealing with delirium since what seems like the beginning of time in medicine, and yet it remains one of the most poorly understood syndromes because it is simply not researched enough and even when research is conducted the outcomes continue to baffle the researchers due to its inconsistency in testing outcomes (Kington & Jenkinson, 2022).

Delirium could be more clearly described as an acute state of confusion that creates changes in behavior, altered levels of consciousness, and increased cognitive impairment as a result of a loss of homeostasis throughout the body (Mitchell et al., 2021).  Obviously, this sudden change in mental status can be upsetting to not only the patient but also their family members, and while it is generally only seen for a few hours up to a few weeks after its onset, it can lead to further complications within the patient's body systems that could ultimately lead to death (Touhy & Jett, 2019).

What should you know about delirium? What are some of the risks? 

The risk of developing it increases with age.

If you suffer from impaired vision, your risk of developing it is increased as well. 

The more medications you take on a regular basis, the higher the risk of development. 

If you are not eating a healthy diet, your risk is higher.

If you have a diagnosis of dementia, you are at an increased risk for delirium. 

If you become dehydrated, it can increase your risk of experiencing delirium. 

What are some of the common symptoms of delirium?

Hallucinations, either auditory or visual, may occur 

You may be easily distracted or have increased difficulty following along in a conversation 

Your behavior may change rapidly and spontaneously throughout the day 

You will have a higher risk of mortality 

You may be diagnosed with symptoms of depression as they often mimic delirium 

You may bounce back and forth in and out of reality or orientation 

(Mitchell et al., 2021). 

How do we treat delirium? Or how can we prevent it from happening in the first place? 

Pharmacological	Non-Pharmacological
Use of haloperidol preoperatively	Encourage patients to wear hearing aids or glasses
Request a review of medications if the patient is taking multiple medications	Providing adequate hydration
	Maintaining a normal sleep-wake cycle
	Keep instructions simple
	Early ambulation after surgical procedures
	Providing the patient with familiar objects
	Maintaining oral contact
	Make sure the patient has support from familiar family members
	Avoid moving them to unfamiliar locations
	Nursing staff complete initial assessment PRIOR to surgical intervention to have baseline cognitive information available for comparison

(NICE, n.d.-a)

As you can see, there are many more non-pharmacological interventions or preventative steps than there are pharmacological ones. The patient, the family, and the medical staff must all be on the same page and communicating throughout to prevent a possible issue. However, even the best prevention does not always keep us from seeing delirium in our older patients after being in the hospital setting. So…we must make sure we are catching the changes early, reporting them, and taking them seriously! 

As someone who is experiencing this situation, like our spouse at the top of this blog – what can you do? What resources are available to help you through this time? 

There is a resource guide available at: 

https://lccrg.com/docs/Lake_County_Resource_Guide4.pdf

Where you can find all types of resources here in Lake County, Florida. Support is available individually as well as in group settings, depending on your personal support needs. 

Also, if this becomes a situation where your loved one needs further mental health support, you can visit: 

https://www.psychologytoday.com/us/psychiatrists/fl/lake-county

For an extensive list of available mental health professionals here in Lake County, Florida. 

References:

Cano‐Escalera, G., Graña, M., Irazusta, J., Labayen, I., & Besga, A. (2021). Risk factors for prediction of delirium at hospital admittance. Expert Systems, 39(4). https://doi.org/10.1111/exsy.12698

Kington, J., & Jenkinson, J. (2022). Delirium: Who cares? Acta Psychiatrica Scandinavica, 147(5), 398–400. https://doi.org/10.1111/acps.13469

Mitchell, G., Scott, J., Carter, G., & Wilson, C. B. (2021). Evaluation of a delirium awareness podcast for undergraduate nursing students in Northern Ireland: a pre−/post-test study. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00543-0

NICE. (n.d.-a). Recognising and preventing delirium. https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/recognising-and-preventing-delirium#preventing-delirium

Touhy, T. A., & Jett, K. F. (2019). Ebersole and Hess’ toward healthy aging: Human Needs and Nursing Response. Mosby.