INDIANAPOLIS, IN ( Ivanhoe Newswire) - An estimated 7 million Americans hospitalized each year have delirium, a condition affecting the elderly that goes undiagnosed 60 percent of the time and can prove deadly. But there are a few things that you can do to protect yourself.
Needle point keeps Rolland Pfile's mind at ease, but a recent stay at the hospital for an emergency surgery had him terrified.
"Almost anything that I heard, I was interpreting as a death threat," Rolland Pfile told Ivanhoe.
"He thought the medical people were trying to kill him and he was trying to escape," Laverne Pfile, Rolland's wife, said.
Rolland was suffering from delirium, a sudden alteration in mental state affecting about 80 percent of patients in the ICU.
"If I'd have gotten a hold of a weapon I would have started firing and [I] could have hurt someone badly," Rolland said.
"Delirium is acute brain failure,"Malaz Boustani, M.D., Regenstrief Institute investigator and associate professor of medicine at Indiana University School of Medicine, said.
Doctor Boustani said it can be just as serious as having a heart attack.
"Your chance of death over the next 30 days doubles," Dr. Boustani said. And it doesn't stop there.
"Your chance of developing full blown Alzheimer's disease over the next 5 years goes up two, sometimes five times, the odds," Dr. Boustani said.
While the exact cause of delirium is not known, Doctor Boustani said it starts by caucusing a spiral inflammation and spiral death for the neuron or brain cells.
In about 40 percent of cases, hospital acquired delirium is preventable. Here's what you can do to help your loved ones.
First, have a list of all the patient's medications. Overmedication can trigger delirium. Second, bring their glasses and hearing aids, and watch for obvious signs like confusion.
"One hour the patient is back to normal another hour the patient is more confused," Dr.Boustani said. "This fluctuation is a red flag."
Finally make things familiar by bringing comforting objects from home to help orientate them. These are tips Rolland's wife wished she had known sooner.
"I knew nothing about delirium. I didn't have a clue," Laverne said.
Until recently, hospital-acquired delirium was chalked up to old age and not considered a condition to be prevented or treated. Doctor Boustani said delirium patients also end up in nursing homes 75 percent of the time, five times higher than those without the condition.
The condition also leads to longer stays in the hospital, up to 10 days longer, costing patients an average $60,000 per hospital stay.
RESEARCH SUMMARY
BACKGROUND: Delirium can be defined as a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. The onset of delirium is often sudden, usually developing within hours or days. The exact cause of delirium is unknown, but can sometimes be traced to a few contributing factors such as medication, a severe or chronic medical illness, surgery, or drug or alcohol abuse.
SIGNS OR SYMPTOMS TO WATCH OUT FOR: Signs and symptoms can be similar to dementia, making input from a family member important when determining the diagnosis. Since onset of dementia is often sudden, symptoms fluctuate throughout the day. A few primary symptoms include:
- Cognitive impairment, or poor thinking skills: Difficulty reading or writing, poor memory, particularly of recent events, difficulty understanding speech, difficulty speaking or recalling words, disorientation, or not knowing where one is, who one is, or what time of day it is rambling or nonsense speech.
- Reduced awareness of the environment: Inability to stay focused on a topic, wandering attention, being easily distracted by unimportant things, getting stuck on an idea rather than responding to questions or conversation.
- Other common symptoms: seeing things that don't exist (hallucinations), disturbed sleep habits extreme emotions, such as fear, anxiety, anger or depression, agitation, irritability or combative behavior.
Elderly people who are recovering in the hospital or living in a long term care facility are particularly vulnerable to delirium. Approximately seven million Americans experience delirium at the hospital a year and is undiagnosed 60 percent of the time.
VULNERABILITY: Delirium occurs when normal receiving and sending brain signals are impaired. The impairment is not exactly known, but a combination of factors could be involved. For example, a patient is more vulnerable when they experience dementia, limited ability to perform everyday activities, severe terminal illness, have HIV/AIDS, abuse drugs or alcohol, have poor nutrition, of older age, or have visual or hearing impairment. Medications, surgery, sudden illness, multiple medications, infection, use of recreational drugs, emotional stress, admission to ICU, and multiple medical procedures are all triggers for delirium in people who are more vulnerable.
WHAT YOU CAN DO: The first goal of treatment for delirium is to address any underlying causes or triggering factors — by stopping use of a particular medication, for example, or treating an infection. Treatment then focuses on creating an optimal environment for healing the body and calming the brain, but it is very important for loved ones to help in the treatment. In order to help loved ones, a person must have a list of all prescriptions and over-the-counter medications, as well as dietary supplements, the patient takes because overmedication can trigger delirium. They must be able to provide the names and contact information of all doctors. It is also important to record the time of onset and a description of symptoms (if onset occurs before they are hospitalized). They need to bring the patients glasses or hearing aids. Finally, a person should brings things familiar from home to help orientate them (Source: www.mayoclinic.com).
FOR MORE INFORMATION, CONTACT:
Cindy Fox Aisen
Regenstrief Institute
Indiana University
caisen@iupui.edu
