All hospitalized elderly patients should be considered high risk for hospital delirium

Far from home

I knew he understood everything.

Just last month, my grandfather was in ICU, a week after major surgery, and decided he wanted to be taken off his ventilator.

The doctors asked him dozens of questions, insisting he couldn’t possibly understand.

But I knew. I knew he understood every word, every question — and what he was asking them to do.

After almost an hour of questions and confirmations, they agreed to honor his request and removed the ventilator. He slipped away peacefully about two hours later.

But now I realize why they were so adamant he didn’t understand them.

They were sure he was suffering from “hospital delirium.”

In my grandfather’s case, it wasn’t delirium. He knew what he was doing and what he wanted. But for far too many patients, this phenomenon causes premature death that could likely be prevented.

Calming a troubled mind

“This is a bomb, the fuse is lit, and no one even sees the burning fuse.”

That’s how Wesley Ely, a dementia researcher at Vanderbilt University, recently described the hospital delirium problem to New Scientist.

And a hospital administrator told the New York Times: “A delirious patient happens almost every day.” He says their experience is “sheer terror, like their worst nightmare.”

This phenomenon is relatively unknown outside the medical world even though it affects a large number of patients. About half of all elderly people who have hip fracture repair experience delirium. And if they’re cared for in ICU, that number jumps to 80 percent.

And the toll is terrible. About three out of four elderly patients with hospital delirium are placed in assisted care, and about one in ten dies within a month.

So it’s vitally important for family and hospital care-givers to know that they can help reduce delirium risk.

The first step is to watch for factors that increase risk.

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

* Antidepressants

* Sleep-inducing drugs

* Antihistamines

* Anti-nausea drugs

* Ulcer drugs

Recently, a Johns Hopkins University study showed that rates of delirium might be cut in half just by using lighter sedation in patients who have hip fracture surgery.

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.

Despite my experience with my grandfather, patients and family members should never 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

Also keep in mind that patients with delirium are often withdrawn and quiet. The word “delirium” suggests agitation, but agitation is not always among the symptoms.

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 (even if they aren’t experiencing delirium).

Sources:
“Delirium in hospital can be a killer for the elderly” Peter Aldhous, New Scientist, 7/27/11, newscientist.com

“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