Friday, July 6, 2012

Hospital-induced Delirium


Photo by Dan Bolton.
[Updated April 9, 2013 to add info on PTSD for patience experiencing delirium while hospitalized.]

When an older adult is hospitalized, family members are already upset and concerned.  Then often the patient falls into a state of agitation, delirium or even psychosis—making an already stressful event even more traumatic.  

Family members may not realize that older adults are more prone to hospital-induced delirium.  

"Delirium occurs in up to 56 percent of hospitalized patients and nearly 80 percent of patients admitted to intensive care units," according to a
study conducted by University of Medicine and Dentistry of New Jersey. Note, these statistics are for patients of all ages; everyone is at risk. 
 
Symptoms include restlessness, agitation, anxiety, confusion, lack of focus, disorientation, speech problems, memory problems, sleep disturbance, trying to pull out lines, trying to rise out of the bed, picking at skin, hair pulling, nightmares, hysteria, hallucinations, paranoia and aggression (spitting, hitting, biting). 

Although this set of symptoms generally show the patient is more worked up than usual, he or she could also be more inert showing symptoms such as fatigue, slurred speech, withdrawal, and unresponsiveness.

This is a difficult situation for medical professionals to diagnose because physiological causes for these symptoms need to be treated or excluded. 


The hospital environment can trigger delirium for several reasons. 

People are in an unfamiliar environment, the room often has no windows and has constant levels of light (denying them the rhythms of night and day), they get little sleep because of noise and medical intervention, they experience powerlessness, they are surrounded by strangers, they lose the comforts of home.  Also, people who do not wear their hearing aids or glasses during their hospital stays are more prone to delirium.

People who are are at risk for hospital-induced delirium have these characteristicsadvanced age, vision and/or hearing loss, 4 or more medications, malnutrition, dehydration, invasive procedures, use of a catheter, use of a ventilator, cognitive problems, and multiple chronic conditions.

Sometimes people in the early stages of dementia may be undiagnosed until a hospital stay. Being outside of their regular environment robs them of their ability to cope, and the underlying dementia finally surfaces—much to the shock of their family. Be careful, however, not to confuse temporary delirium for dementia.  Time and professional testing will determine the difference.

Medical professionals and family members can help to prevent hospital-induced delirium by providing clocks and calendars, including familiar items from home, encouraging visits by friends and family, and providing sensory soothing acts such as massage, music, and soothing conversation.  If the patient becomes severely agitated or combative, hospital staff might administer medications such as sleep aids and anti-psychotic drugs.  Restraints should be avoided if possible because they increase the chance of paranoia. 

While it may be of some comfort to know that hospital-induced dementia disappears after a time, some patients suffer long-lasting effects.  The rate of further hospitalization, the rate of entry into a nursing home and the rate of death for those with hospital induced delirium are higher than for those patients who avoid it.  Another long-term effect is the occurrence of flashbacks or PTSD.  

If you are concerned about hospital-induced psychosis in a loved one, please consult a licensed medical professional. This information is only to raise awareness and is not intended to replace expert medical advice. 

The research employs multiple phrases to describe the altered mental and physical state of someone who has been hospitalized. If you want to learn more about this, employ these terms while researching:
  • Hospital-induced delirium
  • Hospital-acquired delirium
  • Hospital-induced psychosis
  • Hospital-acquired psychosis
  • ICU delirium
  • ICU psychosis
  • ICU syndrome
  • Post-operative delirium
  • Post-operative cognitive dysfunction


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9 comments:

  1. Karen, you've described so many of the symptoms my parents have displayed. Thank you for the tips. I'm forwarding this to my siblings who live close enough to do something about this.

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    1. Barbara: My best to you and your siblings as you negotiate the path of caregivers. It's a challenging time but one that also offers some moments of tenderness. Hugs all the way around.

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  2. My husband is currently experiencing this in the hospital but he is only 52. He does have Multiple Sclerosis. Does this only happen to elderly patients?

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    1. No, it can happen to anyone, but people with memory issues are more prone, and older adults have memory issues at a higher rate.

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  3. I am not a medical professional, so you would do better to ask a nurse. From my limited experience, it can happen to patients of any age. It can be very scary for patient and family member. Sometimes it's an infection, dehydration, or an incorrect dose of medicine, so the doctors and nurses should help exclude causes that need immediate medical attention. Again, I am only raising awareness not dispensing medical advice. Ask a licensed medical professional.

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  4. Please don't characterize ICU delirium as an old person's disorder. It can affect and does affect people of all ages including infants. ICU delirium is to the brain what brain what heart failure is to the heart. Indeed it is brain failure.

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    1. True, as my comment of August 15 concedes, ICU delirium can happen to patients of any age. But I blog about aging. I also have a post about dehydration, one about protein needs, one about calcium, etc. These are all issues for everyone, but all of my posts are about older adults, so I write from that bias.

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  5. My mom is 57 and we have been in the hospital for 40 days now she had 2 surgerys but she has ll the systems that my grandmother did with Alzheimer's but my mom didn't develop this until
    14days. After we got here

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    1. All my best to your mother for a complete recovery.

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