Tag Archives: delirium

Family Caregiver, Hospital Professionals, Senior Care Professionals

Is it Delirium or Dementia – Learn the Differences

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Delirium is an acute disorder of attention and global cognition, including perception and memory, and is treatable.  Learning the differences between delirium and dementia is important for professional and family caregivers, as the diagnosis is missed in more than 50% of the cases.

According to the Alzheimer’s Association, dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia.

Persons who have dementia are at an increased risk of delirium, however, it is important to learn the differences.  Risk factors for delirium include dementia, pre-existing brain disease, medications, and age.

Delirium has serious implications for older adults, especially those who are at higher risks.  Sometimes referred to as hospital delirium or post-operative confusion, dementia-like symptoms can be alarming to families and often misdiagnosed by healthcare professionals.

Patients who experience hospital or post-operative dementia may exhibit symptoms such as agitation, experience hallucinations or delusions, and often extreme confusion.  Conversely, they may become extremely quiet.  Often this is accompanied by a rapid decline in one’s mental state.

Older adult patients in hospitals or in rehabilitation facilities who have undergone surgery, had an infection, experienced trauma, or spent time in ICU are more vulnerable to experiencing delirium.

Examples of delirium causes (or aggravators) may be untreated pain, dehydration,  constipation, fear, and anxiety of a changed environment (such as a hospital setting).   Unfortunately, delirium can be aggravated even more in older adults that are hospitalized, then moved to a skilled nursing facility, where they may be at higher risks of infection and other health complications.

Families must be diligent to note any changes in mental state and discuss these immediately with healthcare professionals.  Because families will be more familiar with their loved ones’ “normal” state (whether that includes any level of pre-existing dementia or not), sharing a baseline of that person’s behavior is important to determine changes that are not normal.

Non-pharmacological management of delirium should be the first approach in treatment.  This may include having someone sit with the person to aid in helping him/her feel secure, utilizing soft music and touch to provide reassurance and calm.  Bring in photographs of loved ones or special memories that may help the person divert attention from strange or new surroundings.

Families should always discuss non-pharmacological treatment before a loved one is administered medications.  If they have had any drug previously for such conditions, such as antipsychotic or sleeping aids and their loved one has had an adverse reaction, be sure to let healthcare professionals know this.  Your goal is to avoid aggravating the condition and potential side effects of withdrawal.

While dementia and delirium differ, it is important to note that behaviors may be similar and that proper communications tools for care partners will prove critical in responding to their unmet needs and determining a safe treatment plan with the best outcomes possible.

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and a passionate advocate for older adults and those who serve them.  She is the creator of the internationally recognized Dementia Live® Simulation Experience and co-developer of Compassionate Touch® training for professional and family caregivers.   Pam may be contacted at pam@AGEucate.com.

References:

Johns Hopkins Medicine

https://www.hopkinsmedicine.org/gec/series/dementia.html#delirium

Aging in the Workplace, Compassionate Touch®, Dementia Live, Hospital Professionals, Senior Care Professionals, The Family Caregiver

Increased Risks for Hospital Patients with Dementia

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Medical Team Working On Patient In Emergency Room

About one fourth of older hospital patients have dementia.  These patients are at an outstandingly higher risk than other patients for:

  • Delirium
  • Falls
  • Dehydration
  • Poor Nutrition
  • Untreated Pain
  • Medication-related problems
  • Wandering
  • Agitated behavior

Because to the stress caused by acute illness and being in an unfamiliar setting, some older patients show signs of dementia for the first time in a hospital.

Delirium is a  disturbance in mental abilities that results in confused thinking and reduced awareness of your environment. The start of delirium is usually rapid — within hours or a few days.

Delirium can often be traced to one or more contributing factors, such as a severe or chronic medical illness, changes in metabolic balance (such as low sodium), medication, infection, surgery, or alcohol or drug withdrawal.

Dementia is the leading risk factor for delirium.  Patients with dementia are actually three to five times more likely than older adult patients to develop delirium in the hospital and two-thirds of delirium in hospitals occurs in patients with dementia.

These high risk adverse health events are rising at alarming rates as our aging population increases rapidly and hospitals are seeing more patients with dementia symptoms.

According to the Hartford Institute for Geriatric Nursing and the Alzheimer’s Association, dementia should be considered a possibility in every hospital patient age 75 and over and can be present in younger patients as well.  People with dementia usually come into a hospital for treatment of their other medical conditions, although some come in because of complications of their dementia.  Of older people with dementia, 30% also have coronary artery disease; 28% congestive heart failure; 21% diabetes and 17% chronic obstructive pulmonary disease (COPD).

Doctors at Lutheran Medical Center in Denver, who serve the biggest senior population in the metro area, have made changes to help their older patients avoid the delirium diagnosis if they have no choice but to go the hospital.

They’ve essentially taken their traditional 42,000-square-foot emergency room and cut it in half, leaving one side equipped as a traditional ER, and turning the other half into a “Senior ER.”

A big key is preventing the all-too-common side-effects of delirium. See a special ER for seniors, equipped with dozens of brilliant features, that speed comfort and care to this population.

http://www.alzheimersweekly.com/2017/05/emergency-room-paradise-heals-dementias.html

Bridging technology, smart design features, reduced noise and training staff to better communicate with patients and families, more hospitals will transition to dementia friendly healthcare communities.   The “frightening” hospital experience for the growing population living with dementia may just be a thing of the past in a few years.

www.AGEucate.com

Pam Brandon is President/Founder of AGE-u-cate Training Institute.   Their mission is developing and delivering cutting edge dementia education and training for health and long term care providers and others.  #DementiaLive #CompassionateTouch