doctor talking with senior man in hospital bed with his wife

With its similarities to dementia, delirium can be a baffling condition to understand and manage. Older adults tend to be prone to delirium, so our in-home care experts have put together the following tips that will help you recognize and react appropriately in the event that you suspect delirium in someone you love.

What is delirium?

Similar to dementia, delirium symptoms include disorientation, confusion and other alterations in mental status. The key difference, however, is the onset of these effects. In dementia, there is a gradual decline in cognitive functioning; with delirium, the change is immediate.

There are 2 forms of delirium:

  • Hypoactive delirium is the most common type, impacting about ¾ of those with delirium. It may present like depression, with lethargy and a slowed reaction time. Other indications include a flat affect, withdrawal from social/once-enjoyed activities, and apathy.
  • Hyperactive delirium produces agitation and restlessness, disorientation, hallucinations, anxiety, rambling, difficulty with concentration, and rapid changes in emotion.

It is important to keep in mind that both forms of delirium can occur at the same time, with the person feeling drowsy and listless one minute and then feeling alert and agitated the next.

Who is usually subject to delirium?

Those at increased risk for delirium include:

  • Anyone who has been hospitalized or had a surgical procedure (as many as 10 – 30% of patients)
  • Those who are approaching end of life
  • Patients in intensive care units
  • People over age 75, specifically those living in nursing facilities
  • People diagnosed with certain ailments: HIV, liver disease, cancer, stroke, or Parkinson’s disease
  • Individuals receiving dialysis
  • People who take multiple medications or diagnosed with multiple chronic conditions
  • Hearing- or seeing-impaired individuals

What causes delirium in older adults?

The primary cause of delirium is often hard to establish, but there are various known contributing factors:

  • Dehydration
  • Insufficient sleep
  • An extreme reaction to an infection
  • Withdrawal from alcohol or drugs or overdose
  • Side effects of certain medications
  • Hypothyroidism and hyperthyroidism
  • Kidney or liver issues
  • Pain

What should you do if you believe a senior is delirious?

Consult with the older person’s doctor right away for an assessment. They may perform some simple preliminary tests, such as asking the individual to solve a basic math problem or to spell a short word in reverse. A physical exam, blood and urine samples, and imaging tests like an x-ray, MRI or CT scan might be ordered to help diagnose the cause.

What treatment is available for delirium in older adults?

The health condition or other reason for the delirium has to first be identified and addressed. Hospitalization is generally required to allow for uninterrupted monitoring of both the delirium itself as well as the treatment being provided. Options include:

  • Fluids/electrolytes in the event that person is dehydrated
  • Antibiotics for any infections
  • Antipsychotic medications to help ease hallucinations and agitation
  • Benzodiazepines if the delirium is related to alcohol or drug withdrawal

What can you do to provide support?

If looking after the individual with delirium at home, the following advice can help:

  • Reassure the person that everything is alright and that you’re right there.
  • Play soothing music that the person likes.
  • Provide healthy meals and make certain the individual is drinking plenty of fluids.
  • Engage in conversations together to orient the person.
  • Motivate the individual to stay physically active (based on the doctor’s instructions).
  • Try to establish regular sleeping patterns by keeping the home bright during the day, limiting napping during the day, and creating a calm, dark, quiet environment at night.

Absolute Companion Care, a provider of Alzheimer’s care in Towson, MD and nearby areas, can be a significant help as well for a loved one with delirium. We’re here for as much or as little assistance and support as needed, day or night. Reach out to us at 410-357-9640 for a free in-home assessment to learn more.