DEAR DOCTOR K:
My elderly mother has a number of health conditions. Over the past year, she has ended up in the hospital four times. The last two times, she became delirious. Is there anything we can do to prevent delirium if she has to have another hospital stay?
Unfortunately, delirium is common among older patients in hospitals, particularly after surgery or during a stay in an intensive care unit (ICU). One-third to two-thirds of elderly hospital patients develop delirium.
Delirium usually comes on suddenly. People with delirium often have a change in their level of consciousness, which can go in two directions. Most often, they are lethargic and don’t respond to things around them. Less often, it’s the opposite: They are agitated, emotional (crying, angry), and very sensitive to light, noise or any change in the environment.
People with delirium also are confused. They may see or hear things that aren’t there, and may not even realize they are in the hospital.
Delirium can increase the time it takes to recover. It can increase the risk of falls, which can lead to serious injury. It also makes existing dementia worse. Some studies find that people with delirium in the hospital, particularly when it is more severe, are more likely to require nursing home placement, and more likely to die.
A new study analyzed the combined results of 14 earlier studies that looked at non-drug strategies to prevent delirium in older hospital patients. They found that simple methods can reduce delirium by 50 percent and the risk of falls by 60 percent.
Some important things that hospital staff can do include:
- Getting patients out of bed and walking as soon as possible;
- Trying to avoid waking patients at night (to give medications or check vital signs, for example);
- Making sure patients drink enough water.
Family members and friends can also help to prevent delirium:
- Bring glasses, hearing aids and dentures to the hospital. Older people do better if they can see, hear and eat.
- Bring in a few familiar objects from home. Family photos, a favorite comforter or blanket, rosary beads or a beloved book can be comforting.
- Keep easy-to-read clocks and calendars visible. One reason people get disoriented in the hospital is that they can’t go by normal cues, such as daylight.
- Talk about personal and current events.
- Remind your loved one that they are in the hospital and why they are there. In simple terms, explain what is being done to help them feel better.
- Spend as much time as possible with friends or family members who are in the hospital. The environment of a hospital will be unfamiliar and frightening, so contact with familiar people anchors an older hospitalized person to reality.
Family members are often the first to notice subtle changes. If you detect any signs that could indicate delirium, discuss them with the hospital staff as soon as you can.