The Dilemma of Delirium in Older Patients

Alzheimer's and Dementia, Assisted Living, Caregiver Corner, Healthy Aging Leave a comment , ,

Ill and hospitalized older people sometimes experience episodes of delirium, a state of confusion and disorientation. For centuries considered a transient and reversible condition, delirium in older people is still viewed by many to be a normal consequence of surgery, chronic disease, or infections.

There is mounting evidence, however, that delirium may be associated with increased risk for dementia and may contribute to morbidity and death. One study found that in a group of 553 people age 85 and older, those with a history of delirium had an eight-fold increase in risk for developing dementia. The researchers also found that among the participants with dementia, delirium was associated with an acceleration of dementia severity, loss of independent functioning, and higher mortality. These findings showed that delirium is a strong risk factor for dementia and cognitive decline in the oldest old.

At NIA and throughout the geriatric research community, momentum is building to better understand the mechanisms involved in delirium and to improve ways to recognize and treat the condition.

Currently, NIA supports several clinical trials focused on finding effective drugs and protocols to prevent or reduce the impact of delirium in hospitalized older people. The goal is to identify a variety of interventions that reduce delirium for patients in intensive care, including the testing of supplements, pain medications, and sedatives that may alleviate delirium in pre- and post-operative patients.

Although delirium and dementia may occur together, they are quite different:
• Delirium begins suddenly, causes fluctuations in mental function, and is usually reversible.
• Dementia begins gradually, is slowly progressive, and is usually irreversible.

Also, the two disorders affect mental function differently:
• Delirium affects mainly attention.
• Dementia affects mainly memory.

Both delirium and dementia may occur at any age but are much more common among older people because of age-related changes in the brain.

If a relative, friend or someone in your care shows any signs or symptoms of delirium, see a doctor. Your input about the person’s symptoms, typical thinking and everyday abilities will be important for a proper diagnosis and for finding the underlying cause.
If you notice signs and symptoms of delirium in a person in a hospital or nursing home, report your concerns to the nursing staff or doctor rather than assuming that those problems have been observed. Older people recovering in the hospital or living in a long-term care facility are particularly at risk of delirium.

Sources: National Institute on Aging (https://www.nia.nih.gov/news/dilemma-delirium-older-patients), Merck Manual, Consumer Version (https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/delirium-and-dementia/overview-of-delirium-and-dementia?query=delirium) , Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386)

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