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Things to remember when a senior with dementia is delirious

BY PURNIMA SREENIVASAN

Delirium is not dementia nor depression. As we revisit Dementia and Alzheimer’s this month dedicated to its awareness, delirium becomes more significant than ever. With growing research on delirium, hospitalization risks, along with morbidities and mortalities related to it, it’s time to understand why we must revisit dementia in the context of delirium.

Delirium is limited not only to the hospitals, but in the community as well. A condition associated with acute brain failure associated with autonomic dysfunction, motor dysfunction and homeostatic failure, according to the National Institutes of Health.

It is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment, per the Mayo Clinic. 

Dementia and delirium are separate entities, though a continuing delirium might cause further cognitive loss. Delirium is often irreversible, affecting cognition permanently. There are many causes of delirium.

Here are some things to remember when a senior with dementia is delirious:

  1. Families need to know if the senior is delirious during and after hospitalizations, as treatments could sometimes harm more then than help.
  2. Decision making is not the right thing when a senior is confused and is diagnosed with delirium.
  3. Re-Evaluating medications, and the person as a whole, is critical to the improvement of a senior from delirium.
  4.  Discharge planning must be considered, wisely and properly, with a delirious senior with dementia.
  5.  Nutrition, physical safety, security, love, and compassion are all ways to treat delirium as well.
  6. No one senior with delirium is the same as the other. Individualized treatment is a must. Families must ask for, and understand all treatment modalities.
  7. Continuous care is far beneficial than fragmented care. This means caring for a senior with dementia and delirium continues beyond the hospital walls.
  8. Risk of harm or injury is higher during delirium and caution is a must to prevent catastrophic changes and incidents.
  9. Alertness and quick identification of root cause is related to recovery and thus a regular uninhibited open-ended discussion with the provider is key in healing from delirium to quite an extent.
  10. Understanding the importance of social, psychological, physical, environmental determinants are absolute essentials. This means reconciling not just chemical drugs, but also the structure and foundations of a senior’s life at home.
  11. Lack of speech, vision, hearing, taste, touch can further worsen delirium at times, hence these should be discussed and conveyed with the provider.
  12. Families or responsible parties must be a part of the entire process, once the senior with cognitive challenges has been diagnosed with delirium.
  13. Diagnosing delirium correctly and not missing it in context of dementia should be a priority of all providers.
  14. It is important to understand that delirium can be a reason for sudden decline and require more hands-on care, new morbidities, and even sudden mortalities. 
  15. Delirium in dementia could become a financial burden, with poor care, as the senior will have be at a higher level of care at the time of discharge. This is also a cause of stress, and a crisis trigger for health issues in the people related to the senior.

Looking back at some of the things described, a commonality is the need for efficient identification and diagnosis. To commit an error is a whirlpool of sorrows to befall on the senior and their immediate caregivers, families and communities. We live in a world where access to care time is being shortened, it’s time to shorten the time to determine the causes of delirium and treatment.

There are advance directives and other choices to be made. However caution must be exercised when a senior with dementia is delirious. Our population is aging and in years to come we will need to depend on better care.

About Purnima Sreenivasan

Purnima Sreenivasan is a Tribune contributor who is a specialist on aging and the founder of mihygge ( mi-hu-ga, meaning "my life’s simple pleasures" ), an aging health tech startup based in the Bay Area, a company working on making senior living and care accessible, affordable and attainable. She can be reached directly at: contact@mihygge.com.

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