DEAR DOCTOR K:
The last time my mother was in the hospital, she experienced delirium. Given her age and state of health, it’s likely she will be hospitalized again. Is there anything I can do to prevent her from becoming delirious the next time?
About half of people over 65 experience delirium — a sudden change in mental status — during a hospital stay. This troubling experience increases their risk for cognitive impairment and dementia after their release.
It’s easy to understand why hospitalization can be disorienting. Patients’ daily routines are overturned. Suddenly they’re dealing with a stream of people they’ve probably never met before. Because of noise, and being awakened for a treatment or a test, it’s hard to sleep through the night. Medications can also affect their mental state. As we age, it becomes even more difficult to adapt to these disruptions.
Dr. Sharon Inouye is a professor of medicine at Harvard Medical School. Decades ago, she recognized that delirium in older patients isn’t inevitable. She and her colleagues designed a delirium-prevention program called the Hospital Elder Life Program (HELP).
HELP identifies patients at risk for delirium and provides them with special care to minimize the main risk factors for delirium during their hospital stay. These risk factors include sleep deprivation, immobility, visual impairment, hearing impairment and dehydration.
HELP doesn’t just reduce the incidence of delirium during hospitalization. It also helps prevent falls, mental and physical declines, and the need for nursing home care. That’s because it is during spells when they are delirious that people climb out of bed, or slip and fall, and fracture bones.
If your mother is hospitalized again, ask whether the hospital has a delirium prevention program. If not, here are several things you can do to help:
- Keep communication simple. In a calm, reassuring voice, state one fact at a time, as you have learned the facts from the doctors and nurses. Do not overwhelm or overstimulate your mother with too much information.
- Help orient the person. If necessary, remind your mother where she is and why. Be subtle about it. Don’t ask her if she knows where she is, and why she’s there. Instead, make comments like “I sure like the nice big windows here at General Hospital, don’t you?” Or “You’re going to feel so much better when the doctors here at General Hospital take out your gall bladder, Mom.”
- Try a hands-on approach. Gently massage or stroke your mother’s arm or back if she finds that soothing.
- Be a companion. Stay in the hospital as much as possible. Arrange with family and friends to visit in shifts so someone can be present around the clock.
- Work with the staff. If allowed, encourage your mother to eat and drink. Accompany her on walks down the hospital corridor.
- Be vigilant. If you detect signs of possible delirium — confusion, memory problems, personality changes — discuss them with the medical staff as soon as you can. Family and friends are often the first to notice subtle changes.