Recognizing Delirium in the Elderly

Delirium is a condition that mostly affects people who enter the later part of their life. Delirium among older people can be prevented and treated. However, geriatric behavioral disorders are often misunderstood as other psychogeriatric conditions such as dementia. Understanding delirium in the elderly is especially needed by family members for proper treatment.

What is Delirium?

Delirium occurs when there is a sudden change in the way an individual thinks and acts. People who experience delirium become confused and unable to pay attention to their surroundings. Their mind is also disorganized. This chronic condition may cause concern for people with delirium, their families, and everyone around them.

Delirium suffered by the elderly may last from a few hours to several days. Visible signs and symptoms may come and go. This behavioral disorder may be reversible by identifying and treating the underlying medical problem. As many as 10-30 percent of elderly patients experience delirium to varying degrees. When there is a psychogeriatric condition, the patient may need a longer hospitalization. The possibility of being treated in a nursing home and the risk of death are also greater.

Delirium commonly occurs in the elderly who are being treated for some specific health problem, either in hospitals, nursing homes, or at home. Therefore, it is important to know the underlying cause. It is also important for family members and caregivers to be educated about how to prevent and to treat delirium, including the signs and symptoms that indicate the elderly need immediate medical attention.

Delirium may inflict serious and long-term consequences. According to a number of studies, there is a link between delirium and increased mortality, risk of falls, and decreased cognitive and functional function in the short and long term.

What is the Difference between Delirium and Dementia, Mental Disorder, and Depression?

Delirium is a type of psychogeriatric conditions. Because of the symptoms similarity, delirium is often misunderstood as dementia, mental disorder, or depression. Those three mental problems are interrelated, but different from each other.

Dementia is a result of gradual decrease in the brain function ability. That’s why the symptoms do not suddenly appear as in delirium. Depression is a mental problem that makes you weak, depressed, and lose interest in almost anything. Delirium may be caused by dementia or depression.

Mental disorder refers to various conditions that affect a person’s thinking, behavior, and mood. That’s why it is incorrect to say that mentally ill people are like vagrants whom we often see roaming down the street. Delirium, dementia, and depression can be classified as mental disorders.

One of the main differences between delirium and other mental problems is that there are no medications or treatments specifically designed for delirium. Individuals who experience delirium due to certain conditions need to be treated for the condition in order to prevent delirium from reoccurring. Meanwhile, if they experience delirium without other diseases, they are required to take steps to prevent delirium symptoms, such as getting enough sleep, eating nutritious foods, and drinking enough water daily.

What Causes Delirium in the Elderly?

Delirium can be triggered by a single cause, but in most cases, there are many influencing factors because it depends on the interaction between predisposing factors (the state of susceptibility to the disease) and precipitating factors (trigger). Causes of delirium include:

• Chronic diseases
• Changes in metabolism
• Surgery
• Exposure to toxins
• Drugs
• Quitting alcohol and certain medications

Risk factors for delirium among older people include:

• Over 70 years old of age
• Experienced delirium previously
• A decrease in thinking skills
• Being treated for a serious illness
• Lack of nutrition
• Dehydration
• Lots of vomiting or diarrhea
• Have vision or hearing problems
• Taking five or more different medications
• Use of breathing machine

According to a recent study, SARS-CoV-2 infection that causes Covid-19 can also trigger delirium among older people in during treatment in hospital.

How to Recognize Delirium?

To identify delirium in the elderly, it is necessary to be aware of three subtypes of delirium: hypoactivity, hyperactivity, and mixed. The subtypes can be identified by looking at symptoms and signs. Hyperactive delirium occurs when the individual feels restless, anxious, and aggressive. Common symptoms include difficulty sleeping, confusion, hallucinations or delusions, and hard to persuade.

Conversely, hypoactive delirium makes the individual withdraws from social life, silent, and drowsy. Symptoms include difficulty concentrating, not aware of surroundings, sluggishness, and loss of appetite. While mixed delirium is a combination of hyperactivity and hypoactivity. Symptoms also vary between the two subtypes throughout the day.

If these signs and symptoms occur, medical examination by a professional is required. There is a special method for detecting delirium called the Confusion Assessment Method. In this procedure, the nurse or doctor treating the patient will ask several questions to find out if the patient has delirium or not.

How to Avoid Delirium?

Delirium in the elderly can be prevented before it leads to worse consequences. Prevention measures include the Hospital Elder Life Program (HELP) to find six risk factors commonly found in seniors with delirium:

• Decreased thinking abilities
• Lack of sleep
• Inertia
• Vision problems
• Hearing problems
• Dehydration

By knowing and treating these risk factors, the incidence of delirium in the elderly can be reduced. However, the severity and recurrence cannot be diminished. Preventive measures that can be taken include frequent reorientation, such as familiarizing the patient with the surroundings. Other methods include being active, ensuring adequate nutrition and hydration, adjusting sleep patterns and times, managing vision/hearing problems, and treating pain.

What are the Therapies and Preventions?

Treatment of delirium in the elderly is different in each patient. One of the determinants the underlying condition of the patient. For example, if a patient has a urinary tract infection, the infection must first be treated. To be sure, elderly patients with delirium behavior disorder require special care from family members or professional caregivers.

Having a companion is necessary to assist patient with daily activities, including monitoring if there are signs and symptoms of delirium that require immediate medical attention. Caregivers can also help with some therapies to create a calm and comfortable environment to keep patient’s mood from disturbance.

Caregivers may also take a prevention measure by training the patients’ awareness of everything around them, administering medications safely, helping them sleep better, and actively communicating with them. Caregivers play an important role in assessing the patients’ condition, identifying early risk factors and symptoms, implementing prevention strategies, and assisting in the management of delirium among older people.