Delirium Part 3 of 3 Parts


Effects of Delirium


· Delirium has an enormous impact upon the health of older people. Patients with delirium may experience prolonged hospitalizations and a decreased ability to function independently.

· Delirium can be frightening for the patient.


Even patients that appear to have recovered from delirium may have trouble remembering medications and self-care instructions. https://www.uptodate.com/contents/delirium-beyond-the-basics


Cognitive and memory problems are not the only effects. Symptoms of post-traumatic stress disorder are also common in people who develop delirium. https://en.wikipedia.org/wiki/Delirium

Delirium affects an estimated 14–56% of all hospitalized elderly patients. At least 20% of the 12.5 million patients over 65 years of age hospitalized each year in the US experience complications during hospitalization because of delirium.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065676/


“Delirium is associated with a variety of complications, ranging from patient and family stress, increased hospital costs, increased duration of hospital stay, escalation of care, and increased mortality and morbidity including institutionalization,” said Terry Goldberg, PhD a professor of medical psychology (in psychiatry) and anesthesiology at Columbia University Vagelos College of Physicians and Surgeons”…. https://www.columbiapsychiatry.org/news/delirium-may-cause-long-term-cognitive-decline#:~:text=%E2%80%9CIn%20our%20study%2C%20we%20discovered,who%20did%20not%20experience%20delirium.


What are the Treatments for Delirium?


There is no specific treatment for delirium. Instead, treatment focuses on several basic principles:

· Avoid factors known to cause or aggravate delirium, such as certain medications

· Identify and treat the underlying illness

· Provide supportive and restorative care

· Control dangerous and disruptive behaviors to avoid harm to the patient or others

https://www.uptodate.com/contents/delirium-beyond-the-basics


The initial treatment for Delirium often begins in a hospital setting. This allows the health care provider to monitor the patient, begin treatment of the underlying problem, and develop a long-term care plan with the patient and/or family.


Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time - weeks or sometimes even months. In the meantime, there may be treatments to manage the symptoms, such as:


· Controlling the environment, which includes making sure that the room is quiet and well-lit, having clocks or calendars in view, and having family members around

· Medicines, including those that control aggression or agitation and pain relievers if there is pain

· If needed, making sure that the person has a hearing aid, glasses, or other devices for communication

https://medlineplus.gov/delirium.html

Multiple guidelines recommend that delirium should be diagnosed when it presents to healthcare services. Much evidence reveals, however, that delirium is greatly under-diagnosed. Higher rates of detection of delirium in general settings can be assisted by the use of validated delirium screening tools. Many such tools have been published. https://en.wikipedia.org/wiki/Delirium


We all know that healthcare systems could do better in detecting delirium - this remains a major priority. But we know from studies that even in patients with a diagnosis that families are often left in the dark. Many families do not know what delirium is and how to recognize it. So, when sitting with their family member with delirium they may think that the person has developed dementia. https://www.deliriumwords.com/


Studies comparing clinical documentation with research assessments suggest that only 12 to 35% of delirium cases are recognized. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706782/


How do you talk to someone with delirium?

Stay calm; talk to them in short, simple sentences and check that they have understood you, repeating things if necessary. Remind them of what is happening and reassure them about how they are doing. Having someone around that they know well, or even some familiar objects from home, can really help. Mar 15, 2021 https://www.columbiapsychiatry.org/news/delirium-may-cause-long-term-cognitive-decline


In my case, the nurses knew I had Delirium and, yet, I wasn’t treated, (of course, maybe I was and don’t remember). The fact that there is no comment in my records noting the Delirium I assume is an oversight. I’m debating sending a friendly letter to the hospital about my Delirium and lack of treatment.


Can Delirium be Prevented?


“Researchers estimate that about 40 percent of delirium cases are preventable. Many cases are triggered by the care patients receive — especially large doses of anti-anxiety drugs and narcotics to which the elderly are sensitive — or the environments of hospitals themselves: busy, noisy, brightly lit places where sleep is constantly disrupted and staff changes frequently.”

https://www.washingtonpost.com/national/health-science/the-perils-of-delirium/2015/06/01/0f263996-ed22-11e4-8666-a1d756d0218e_story.html

by Sandra G. Boodman, June 2, 2015


Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that the room is kept quiet, calm, and well-lit. It can also help to have family members around and to have the same staff members treat the person. https://medlineplus.gov/delirium.html


Delirium may be prevented and treated by using non-pharmacologic approaches focused on risk factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep deprivation, functional decline and removing or minimizing problematic medications.


Ensuring a therapeutic environment e.g. individualized care; clear communication; adequate reorientation and lighting during daytime; promoting uninterrupted sleep hygiene with minimal noise and light at night; minimizing bed relocation; having familiar objects like family pictures; providing earplugs; and providing adequate nutrition, pain control, and assistance toward early mobilization can also yield benefits toward preventing. https://en.wikipedia.org/wiki/Delirium


Delirium is now taught or at least mentioned in every medical and nursing school in the country. That’s a huge change from a decade ago. https://en.wikipedia.org/wiki/Delirium


Delirium Recovery


Newly diagnosed delirium can herald a life-threatening emergency, and affected patients require a prompt and appropriate evaluation….

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255198/


… [Delirium] is common among patients recovering from surgery and in those with something as easily treated as a urinary tract infection. Regardless of its cause, delirium can persist for months after discharge.


About 5% to 10% of older adults who are admitted to hospital develop a new episode of delirium while in hospital.


The classic teaching is that delirium is transient; however, a growing literature shows that this is not always true. A systematic review showed that incident hospital delirium persisted at hospital discharge in 45% of cases and 1 month later in 33% of cases.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706782/#:~:text=Delirium%20is%20extremely%20common%20in,hospitalization%20in%20the%20other%20half.


Remembering their Delirium Experience


The psychological consequences in patients who recover from delirium include the inability to remember their experience of delirium and those who are able to recollect it describe it to be an unpleasant experience. https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.13110329


Those who recollected their experience commonly described their experience as a state of fearfulness, anxiety, and a feeling of confusion and strange. Occasional patients described the presence of visual hallucination and illusions during the episode of delirium and reported distress due to the same. https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.13110329


One third (35%) of the patients could recollect their experiences during the delirium, and the majority (86%) of them were distressed by these experiences. The level of distress was moderate in most of the subjects (52.5%). Fear and visual hallucination were the most common distressing themes recollected. Oct 31, 2014 https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.13110329


Cognitive Decline


“…delirium was associated with increases in cognitive impairment or dementia incidence at least three months after the patient experienced an episode of delirium and found that patients who experienced delirium demonstrated significantly greater cognitive decline than those patients who did not experience such an episode.


“The researchers also examined whether delirium unmasks cognitive decline in those individuals who were already compromised and on a downward trajectory or whether delirium may potentially cause cognitive decline…The researchers found consistent evidence that delirium was causative in decline.


A new study of 24 observational studies from researchers at Columbia University…

found that delirium may cause significant long-term cognitive decline. The findings were published in JAMA Neurology.”Jul 13, 2020 https://www.columbiapsychiatry.org/news/delirium-may-cause-long-term-cognitive-decline

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