Helping Older Adults Prevent and Manage Delirium

Cynthia Lopinto Feature Article Leave a comment 2,784 Views

(NAPS)—Feeling disoriented can be an upsetting experience for anyone, but for older adults coping with a medical condition called “delirium,” it can be particularly disturbing.

Delirium is a sudden change in mental function that can cause an older person to behave differently than he or she normally would. Some people become aggressive and agitated when they have delirium, others become sleepy and inactive, and others can experience some combination of the two. They may also appear confused about where they are or the time of day, or they may say things that do not make sense.

Delirium Triggers

While researchers have yet to pinpoint the exact causes of delirium, certain risk factors are well established. For example, older people who undergo surgery are particularly susceptible to a form of delirium known as “postoperative delirium.” Other common triggers include:

Changes in medications, such as starting a new medication or increasing the dose of an older one;
Dehydration;
Common lung or urinary tract infections;
Vision or hearing problems;
Conditions affecting the brain, such as infection, internal bleeding, or stroke;
Urinary or intestinal problems, such as constipation or the inability to urinate; and
Problems with the heart or lungs, including heart attacks or lung disease.

“Delirium in any form is serious, and postoperative delirium is the most common complication in older adults who have had surgery,” said Sharon K. Inouye, M.D., M.P.H., Professor of Medicine at Harvard Medical School and Director, Aging Brain Center, Institute for Aging Research, Hebrew Senior Life. “Thankfully, studies have shown that delirium is preventable in up to 40 percent of cases involving older adults in the hospital.”

New Guidelines

The American Geriatrics Society recently released guidelines to help health care professionals prevent and manage postoperative delirium in older people who are preparing to have surgery or who are in the hospital following surgery.

These guidelines recommend screening older adults before surgery for factors that can contribute to delirium, such as being older than age 64 or having poor vision or hearing, a severe illness, an infection, or a memory problem such as dementia.

Delirium After Surgery

“Some causes of delirium, like postoperative delirium, can be managed or prevented,” said Thomas Robinson, M.D., Professor of Surgery, University of Colorado School of Medicine. “Health care professionals should consider working with a coordinated team of specialists who can use multiple approaches for treating the condition. These can include improving the patient’s sleep or encouraging him or her to engage in therapeutic activities, such as games, conversation, or physical activity,” he added.

If you are an older adult facing surgery, be sure to discuss the possibility of developing delirium with your family or friends, as well as your health care team. Recommendations for preventing delirium often include drinking plenty of fluids to stay hydrated and ensuring adequate nighttime sleep by wearing earplugs and eye masks at night and minimizing daytime napping.

If you are concerned that a family member, friend or someone you know may be experiencing a delirious episode, alert a health care professional as soon as possible, and try to help orient older adults by reminding them where they are, what time of day it is, and by showing them familiar items such as family photos. Additionally, if you are taking care of a hospitalized older adult:

Alert hospital or other health care staff right away if you notice sudden confusion or abrupt changes in behavior. You are likely to know the older person in your care best and are tuned in to even small changes in his or her behavior.
Make sure to bring the older adult’s glasses/hearing aids to the hospital. This can protect against disorientation due to vision and hearing problems.
After cleared by the health care team, help the older adult walk several times a day. This is key to recovering from surgery and helps protect against delirium.
Talk to health care professionals about minimizing the use of sleeping medications, re straints or bladder catheters, which can contribute to delirium.
Stay with the older person after he or she is released. Having someone familiar around can help address feeling strange or confused when making the transition to being back home.

For more information about helping older adults cope with delirium and its effects, visit www.HealthinAging.org

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Cynthia Lopinto

Cyn LoPinto, M.A. is a gerontologist focusing on significant issues affecting older adults and their families. Her areas of interest include lifestyle enrichment, family dynamics, and caregiver support. Cyn has worked in both the recreational and healthcare industries.