Color & Control:

Hospital delirium:

The who, what, when, where, how and why.

There’s not much discussion about a condition commonly referred to as hospital delirium. In fact, this temporary state is something many caregivers haven’t heard anything about until it happens amidst considerable stress, physical restraint, and the risk of other potentially serious complications. 

Keep reading to learn how to identify when hospital delirium is happening, how to prevent it and how to communicate with hospital or nursing home staff when it seems to be occurring.  

Just what  is hospital delirium?
Let’s start with looking at the word delirium. Delirium is a state of worse-than-usual mental function, brought on by illness or stress on the body or mind. 

Although people with dementia and Alzheimer’s are more prone to delirium than those without, the condition can, and does, affect many aging adults.

Delirium is serious and very common during hospitalization; with approximately half of the older patients affected.

Identification and treatment are key as delirium has been shown to be related to poorer than expected health outcomes such as falls, longer than previously predicted hospital stays, and increased rates of cognitive decline. 

Know that onset builds up and is often multifactorial. There isn’t a single cause, or event.  Rather, many triggers can combine to create behaviour that are uncharacteristic.

Delirium is often missed by hospital staff who are busy and unfamiliar with your loved one. They
may not notice the bewildered or confusion and could misinterpret restless behaviours. 

Prevention matters!
In some cases the onset of delirium is hard to avoid but there are ways we can minimize its effects: 

• Minimize sleep deprivation – Ask the night nurse for a quieter room, minimize lighting and, if possible, keep the door ajar. Advocate for privacy and minimal disruptions. Do not suggest a sedative as it can further contribute to a person’s state of delirium.

• Minimize vision and hearing loss – Try to have the person’s regular glasses and/ hearing aids available. 

• Provide familiar objects – A family photo or two, a blanket from home, a simple pillow, robe and slippers may bring a sense of the familiar and comfort. Even a family member or friend at their bedside can help give an orienting sense.

• Avoid over stimulation – Opt for a calm reassuring presence. Keep instructions or discussions simple and easy to understand.

• Encourage mobilization and physical activity – it’s usually important to encourage safe physical activity as soon as possible. (check with nurses first to be sure)

• Minimize pain and discomfort – inquire to pain levels  or constipation. It’s not unusual for pain to be overlooked or
inadequately treated without the caregivers help.

• Restraints are a last resort – Question staff if they suggest restraining the patient. This could add to everyone’s stress, and ultimately increase confusion or extend the delirium.

Be aware and speak up
Being alone and disoriented can be frightening for a person who is experiencing it, and by extension, their attending family member. However, if you believe your elder is becoming delirious, don’t panic, it will only add to the stress. 

Once delirium is officially diagnosed/ identified, staff will assist with removing as many triggers as possible and assist with the provision of supportive care. Again… its safety first. Preventing injuries and managing difficult behaviours during a state of delirium is key.

Depending on the facility’s amenities, you can request use of a calm restorative space where the patient can recover. Some hospitals are actually able to provide a “delirium room” that is especially equipped.

The after-math
Even when prevention measures are taken and restorative spaces given, we need to keep in mind that it can take a while for delirium  to subside. 

It can often take weeks, sometimes months, for the person to return to being themselves. In some cases, the person never recovers to the extent that we hoped they would, and unfortunately, we must be prepared to face whatever the “new normal” happens to be.   

Kylie MacKenzie is an on-staff writer with the Canadian Abilities Foundation (CAF).

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