Illusions and Delusions-Part III-Medical Condition Delirium
Delirium is a syndrome of disturbed consciousness,
cognition and perception that develops over a short period of
time and tends to fluctuate during the course of the day and is
caused by one or more physical conditions. Delirium results from
a disturbance in the neurotransmitters (chemical messengers) in
the brain that control consciousness, thinking and behavior.
The hallmarks of delirium are an abrupt onset of depressed level
of consciousness, alterations in memory and behavior, and
sometimes hallucinations. It is more common in older adults,
possibly due to normal age-related changes in the nervous system
and brain, diminished eyesight and hearing associated with age,
greater use of medications in elderly patients, and diseases that
injure the brain and predispose to delirium. For example,
it is known that the condition dementia places a person at higher
risk for developing delirium than people who are not afflicted
with dementia.
Researchers at medical centers have been looking into this
phenomenon for years. One POTENTIAL PREVENTATIVE STUDY came from
the group at Yale University Medical Center who reported in NEJM.
(See: Inouye et al. NEJM. 1999; 340:669-676.). The group found
that in a group of hospitalized general medicine patients aged 70
or above who had no delirium at admission, 10-15% of the group
went on to develop delirium after admission. They identified the
risk factors for delirium as related to visual impairment, severe
illness, cognitive impairment and abnormal renal function blood
tests.
They attempted an intervention program, Elder Life Program, which
they hoped would reduce the risk of delirium. This intervention
employed a specialist in geriatrics and trained volunteers who
instituted the following activities:
· Activities to stimulate the mind.
· Special efforts to keep patient oriented while in hospital.
· Avoiding excessive bed rest and keeping patient mobile.
· Promoting sleep without the use of hypnotic drugs and ensuring
the environment was conducive to sleep.
· Reminders to bring and use communication devices (e.g. hearing
aids, eyeglasses etc.).
· Providing aids to promote communication such as magnifying
glasses, large print glasses, clearing wax from ear canals.
· A protocol to detect and treat low fluid intake (dehydration).
This intervention reduced the incidence of delirium by
40%, as well as reduced the number of days of delirium and the
number of episodes of delirium. Lower risk patients benefited
most from this program. Those with marked dementia did not
benefit in any appreciable way.
Measures to identify and prevent delirium from occurring have
been identified, though it will not be eliminated. More basic
clinical and neuroscience investigation are needed to help reduce
the incidence of this troubling issue so that many elderly can
enhance the quality of their lives, not fearing entering a
hospital and undergoing clinical treatment because of potentially
aversive effects of hospitalization. Let us hope that the current
difficult fiscal times will not interfere with such programs of
proven value.
Illusions and Delusions in the
Elderly-Part I
Illusions and Delusions-Dementia Delirium-Part
II
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Harold Rubin, MS, ABD, CRC, Guest Lecturer
April 19, 2003
http://www.therubins.com
To e-mail: rehabstrat1@aol.com or rubin@brainlink.com