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Delirium Is Often Mistaken for Dementia: Know the Signs

delirium in seniors

Delirium often affects hospitalized seniors

If an older adult with no history of cognitive impairment suddenly starts having cognitive issues during or after a hospitalization, it’s most likely not dementia – it could be delirium.

People with delirium often have terrifying hallucinations, delusions, and are unable to think clearly or focus. In older hospital patients, these symptoms can be misdiagnosed as dementia.

Delirium is a serious condition that causes a great deal of suffering on top of the medical condition that landed the person in the hospital in the first place.

And sometimes, recovering from delirium takes far longer than recovering from the medical condition.

We explain how delirium is different from dementia, what happens when someone has it, what causes it to happen, and how to prevent it.


Delirium is different from dementia

Delirium and dementia are two different medical conditions.

Dementia develops gradually and gets progressively worse.

Delirium happens suddenly and typically changes during the course of a day. Some patients with delirium are agitated and combative and others are sleepy and can’t pay attention.

In a Kaiser Health News article, it’s reported that delirium affects 7 million hospitalized Americans each year. It can happen at any age, but delirium is more common in hospitalized people older than age 65.

As if the delirium itself wasn’t bad enough, research has also linked it to longer hospital stays, greater risk of falls, increased risk of developing dementia, and an increased death rate.

What happens when someone has delirium?

People with delirium have cognitive and memory problems, hallucinations, and symptoms of post-traumatic stress disorder (PTSD).

One man with delirium had terrifying hallucinations, including one where he was on stage covered in blood. Another had hallucinations about being burned alive.

Psychologist James C. Jackson of Vanderbilt’s ICU Recovery Center says these horrible experiences are typical.

Some delusional memories are distortions of things that have actually happened – like patients who got catheterized thinking they were sexually assaulted or people getting MRIs thinking they were being put into a giant oven.

What causes delirium in hospitals?

Delirium is more likely to develop when patients are in intensive care, heavily sedated, and on ventilators – up to an 85% chance.

It’s also common when patients are recovering from surgery and even with something as simple as a urinary tract infection.

Unfortunately, once the delirium starts, it can last for months.

Delirium is preventable

Researchers say that about 40% of delirium cases are preventable.

But Dr. Sharon Inouye, a geriatric doctor and Harvard Medical School professor of medicine says, “Delirium is very underrecognized and underdiagnosed…physicians and nurses often don’t know about it.”

She also says that preventing delirium is crucial, because “there still aren’t good treatments for it once it occurs.”

Many cases are triggered by treatments that older adults are especially sensitive to, like large doses of anti-anxiety drugs and narcotics.

Other cases are caused by the busy, noisy, brightly lit environments where sleep is constantly interrupted and the staff keeps changing.

How to prevent delirium in seniors during hospitalization

Some hospitals are trying to prevent delirium by being more careful about medication, especially benzodiazepines.

They’re also trying to get ICU patients off breathing machines sooner, limit the use of restraints, and get patients out of bed and moving sooner.

And some hospitals are making the environment more pleasant by turning off room lights at night, installing large clocks, and keeping noisy machine alarms to a minimum.

When you’re advocating for your older adult in the hospital, ask for these types of modifications to reduce their risk of developing delirium.

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By DailyCaring Editorial Team Image: Western Alzheimers

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