doctor talking with senior man in hospital bed with his wife

With its parallels to dementia, delirium is often a baffling problem to identify and manage. Older people are particularly susceptible to delirium, so our aging care experts have put together the following insights that will help you recognize and react appropriately in the event that you suspect it in someone you love.

What is delirium in seniors?

Much like dementia, delirium symptoms involve disorientation, confusion, and other changes in mental status. The important contrast, however, is the onset of these effects. In dementia, there is a gradual decrease in cognitive functioning; with delirium, the transformation is sudden.

There are two forms of delirium:

  • Hypoactive delirium is the most prevalent form, affecting roughly three-quarters of those with delirium. It may present similarly to depression, with lethargy and a slowed response time. Other indications include apathy, a flat affect, and withdrawal from social situations or previously-enjoyed activities.
  • Hyperactive delirium produces agitation and restlessness, disorientation, hallucinations, anxiety, rambling, difficulty with concentration, and rapid changes in emotion.

It’s important to note that both types of delirium can happen simultaneously, with the person experiencing listlessness and drowsiness one moment and then feeling alert and agitated the next.

Who is typically impacted by delirium?

Those at heightened risk for delirium include:

  • Anyone who has been hospitalized or had surgery (as many as 10 – 30% of patients)
  • People who are getting close to the end of life
  • Patients in the ICU
  • Seniors over age 75, especially those residing in assisted living facilities
  • People clinically determined to have certain conditions: Parkinson’s disease, liver disease, stroke, cancer or HIV
  • Individuals receiving dialysis
  • People who take multiple medications or who are diagnosed with multiple chronic illnesses
  • Those who are hearing- or seeing-impaired

What causes delirium?

The primary cause of delirium in seniors is often difficult to identify, but there are a variety of known contributing factors:

  • Dehydration
  • Insufficient sleep
  • An extreme response to an infection
  • Withdrawal from alcohol or drugs or overdose
  • Side effects of certain medications
  • Hypothyroidism and hyperthyroidism
  • Kidney or liver issues
  • Pain

What should be done if you believe a loved one is delirious?

Contact the older person’s healthcare provider right away for an assessment. They may conduct some simple initial tests, such as asking the individual to solve a basic math problem or to spell a short word backwards. An x-ray, physical exam, blood and urine samples, and imaging tests like an MRI or CT scan may be ordered to help establish the cause.

What treatment solutions are available for delirium?

The health condition or other cause of the delirium has to first be established and treated. Hospitalization is oftentimes needed to allow for continuous monitoring of the delirium itself as well as the treatment being provided. Options may include:

  • Fluids/electrolytes in the event that person is dehydrated
  • Antibiotics for any infections
  • Antipsychotic medications to ease agitation and hallucinations
  • Benzodiazepines in the event that delirium is related to alcohol or drug withdrawal

What can you do to help?

If caring for an individual with delirium at home, the following advice can help:

  • Reassure the person that everything is ok and that you’re right there.
  • Play calming music that the person enjoys.
  • Provide nutritious meals and make certain the individual is drinking plenty of fluids.
  • Engage together in conversations to orient the person.
  • Motivate the person to remain physically active (based on the doctor’s guidelines).

Try to establish regular sleeping patterns by keeping your home bright throughout the day, limiting napping during the day, and creating a calm, dark, quiet environment in the evening hours.

Grace Home Care’s caregivers in Topeka can be a significant help as well for someone experiencing delirium. We are here for as much or as little assistance and support as required, day or night. Contact us at 785-286-2273 for a free in-home assessment to learn more.