There’s a secret behind the calm exterior of nearly every hospital

The Hidden Delirium

One night many, many years ago, I was staying over at a friend’s house. I got up in the middle of the night to use the bathroom. Not remembering where I was, I came within milliseconds of using her mother’s houseplant instead — because it was in the same spot where my bathroom was at home.

I’m sure we all have our own funny stories about waking up dazed or confused when we’re away from home.

But when it happens in the hospital, it’s not so funny. In fact, it can be terrifying and downright dangerous.

As one hospital administrator told the New York Times, “A delirious patient happens almost every day.” And he describes their experience as “sheer terror, like their worst nightmare.”

This phenomenon is most likely to affect patients who have had surgery, especially those in intensive care. And it occurs most frequently in older patients. In fact, about one out of three patients over the age of 70 will develop hallucinations that seem horrifyingly real.

It’s a cruel condition, darkened by the shadow of dementia.

Records show that patients who already have dementia are at higher risk of hospital delirium, and healthy patients who lapse into temporary delirium are at higher risk of developing dementia later in life.

For the elderly, the outlook is even worse. About three out of four patients with hospital delirium are placed in assisted care, and about one in ten dies within a month.

Watching for signs

Fortunately, there are steps that family and hospital care- givers can take to reduce the risk of delirium. Step one: recognize factors that increase risk.

For instance, these drugs have been linked to hospital delirium:

• Antidepressants
• Sleep inducing drugs
• Antihistamines
• Anti-nausea drugs
• Ulcer drugs

But even with no drug use, hospital delirium can be triggered by disorientation caused by disruption of daily routines, isolation from immediate family and pets, a strange room, room changes, constant nighttime activity, interrupted sleep, and repeated tests.

Patients and family members should not assume that hospital personnel are on the lookout for delirium. In fact, this is where family can play an important role. Doctors and nurses who are unfamiliar with a patient are less likely to spot behavior that deviates from a patient’s norm.

These are symptoms family members should look for:

• Confusion and poor concentration
• Suspicious, anxious, or fearful behavior
• Slurred speech
• Patient doesn’t recognize family members
• Distorted visual perceptions

Dr. Sharon Inouye and colleagues at Yale University School of Medicine have created Hospital Elder Life Program (HELP) to address issues like hospital delirium. When possible, before being admitted to the hospital, elderly patients can check with hospital administrators to see if they’ve incorporated the HELP program as part of their patient care regimen.

Also, families can go to the HELP website (hospitalelderlifeprogram.org) for tips on helping elderly patients avoid confusion. Little things can make a big difference–such as bringing in familiar objects or photos from home, making sure glasses and dentures are handy, giving an occasional shoulder or foot massage, and preparing a detailed medical information sheet about the patient for doctors and nurses.

And of course it always helps to have a reassuring immediate family member close at hand.

To Your Good Health,

Jenny Thompson

Sources:
“Hallucinations in Hospital Pose Risk to Elderly” Pam Belluck, New York Times, 6/20/10, nytimes.com
“Detecting Hospital Delirium” Johns Hopkins Health Alerts, 6/16/08, johnshopkinshealthalerts.com