Delirium: When the Hospital Doesn't Agree with Your Elderly Parent
When an elderly parent is hospitalized, whether planned or unplanned, it's a stressful time for caregivers. Add hospital delirium to the mix and things can get overwhelming fast. I recall after my mother fell and was hospitalized for a fractured spine, she was convinced that a cat was in the tree outside her rehab facility window and that there was an old man's face on the cart of clean linen in the hallway.
Delirium can come on quickly and often results in confusion, hallucinations, and uncharacteristic behaviors. Unfortunately, it happens more often than one might think. Consider these statistics from the American Nursing Association:
Delirium occurs more frequently in patients 70 and older.
As many as 50% of dementia patients who are hospitalized experience delirium.
Delirium is seen in as many as one quarter of hospitalized patients, half of patients who undergo surgery, and three quarters of patients who are admitted to the intensive care unit.
Fortunately, awareness about delirium is on the rise in the medical community and there are things that both clinicians and families can do to reduce the likelihood of delirium developing.
What Causes Delirium?
Researchers have identified several contributors to delirium. These include dementia, infections, physical trauma resulting from an injury or surgery, pain, and unfamiliar surroundings. Harvard Health Publishing suggests that brain chemistry also plays a role.
When levels of the neurotransmitter acetylcholine drop in the brain, delirium is more likely to develop. The elderly are already at a disadvantage since, their bodies produce less acetylcholine. Other factors affecting acetylcholine levels include low blood sugar, inadequate oxygen to the brain, and pharmaceuticals that inhibit the effect of acetylcholine in the body.
Preventing delirium is desirable for many reasons, not least that extended periods of delirium have been correlated with higher mortality rates and poor long-term outcomes among patients.
Preventing Delirium: Clinicians and Caregivers Both Play a Role
Medical experts believe that around 40% of delirium cases can be prevented. Dr. Sharon Inouye of Harvard Medical School has developed the Hospital Elder Life Program (HELP). Hospitals that adopt HELP conduct an interdisciplinary geriatric assessment to identify patient-specific risk factors for delirium. This is used in combination with a volunteer model which offers personal attention to older patients. Key components of the program include daily orientations, early mobilization, assistance with eating, ensuring that patients can see and hear well, and promoting sleep without the use of pharmaceuticals.
Caregivers also play a central role, especially if the family member succumbs to delirium. The American Delirium Society offers several recommendations, including:
Advocate for your family member. Communicate with clinicians about what's "normal" for your family member, so they understand what his or her "baseline" usually is.
Be clear, concise, and patient with your family member. Accept that they may not recognize you. When providing directions, use simple language.
Recognize that your presence provides a sense of familiarity. It can be helpful to bring objects in from home. Bring hearing aids and glasses to assist with auditory and visual perception.
Based on my personal experiences with hospital delirium in both of my parents, I have three caregiver-centered recommendations:
Be proactive and ask the clinical team what steps they plan to take to prevent or reduce the likelihood of delirium for your family member. This advice is relevant for both planned and unexpected hospitalizations. With planned hospitalizations, it may be easier to have the conversation since stress levels aren't running as high. Ask whether the hospital has adopted the HELP protocol.
Remember to balance self-care with caregiving. Many doctors recommend staying with delirium patients around the clock. While this may be a best practice, recognize that this simply may not be possible given your personal situation. After my father had his heart surgery, one of the nurses chided me for not staying all day, every day with him. As the only child, this couldn't happen. I knew I was starting a journey that would be a marathon – burning out in the first two weeks wouldn't do anyone any good.
Take a step back and consider whether the benefit of the hospitalization will outweigh the potential costs. With many health conditions, hospitalization is really the only option. As individuals get older, however, they may prefer palliative care or other care options that don't require hospitalization.
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