Imagine that an elderly person in your household, perhaps your mother, father, grandmother or grandfather, was fine yesterday, but suddenly behaves completely differently today. Their speech is slurred, they may not recognize you, they may not even know where they are or what time it is. This sudden state of confusion, agitation and changes in thinking is what we medically call 'delirium'.
Simply put, what is Delirium?
Delirium is a temporary confusional state of the brain that occurs suddenly, over a period of hours or days. It affects your thinking, memory, awareness of your surroundings, and ability to concentrate. This can cause you to behave very differently from how you normally would.
The important thing is that delirium is a medical emergency . It is not a gradual memory loss like dementia. It is something that comes on suddenly. However, sometimes a person with dementia is more likely to develop delirium.
The best part is that if the cause is found and treated quickly, the condition can often be completely cured. However, if left untreated, it can cause long-term damage to brain function, and in some cases, even death.
Are there main types of delirium?
Yes, Delirium can be divided into three main types. These classifications are based on the way the patient behaves. Sometimes these types can switch back and forth.
| Delirium type | How are the features? |
|---|---|
| Hyperactive Delirium | This is the type we see most often. The patient becomes very restless and agitated. They don't stay in one place. They may scream, try to get out of bed, or try to remove the saline tube in their hand. They are clearly disoriented. |
| Hypoactive Delirium | This type is a little difficult to recognize. Because the patient is very quiet, sleepy. They don't respond properly when spoken to. They are very slow. Many people may dismiss this as fatigue due to the illness. But this is also a dangerous condition. |
| Mixed Delirium | In this case, the symptoms of both types mentioned above are alternated. You may be very agitated at one time of the day, and very quiet and sleepy at another time. |
What are the symptoms of this condition?
The symptoms of delirium can vary from person to person. Also, symptoms do not always occur throughout the day, they come and go. Often, symptoms are worse at night.
Here are some of the main features you will see:
- Loss of awareness of surroundings: Unable to accurately say things like where you are (at home, in the hospital), what day it is, or what time it is.
- Difficulty concentrating: Unable to focus on one thing. Quickly forgets what is being said. Unable to keep thoughts in one place.
- Memory problems: Forgetting recent events, people's names, and events.
- Difficulty speaking: Difficulty forming words, incoherent speech, and irrelevant answers to questions.
- Behavioral changes: Suddenly becoming angry, agitated, sad, very restless. Sometimes very slow, sleepy.
- Changes in sleep patterns: Feeling sleepy during the day and waking up at night. Sleep completely reverses.
- Hallucinations: Seeing things that are not really there (such as insects, animals, people), hearing sounds that are not really there.
- Delusions: Believing that things are true even when they are proven to be false. For example, thinking that someone is trying to poison them or that they are being held captive.
What are the causes of delirium?
Delirium is not caused by the stress we face in our daily lives. It occurs when the body or brain is subjected to physical stress that cannot be tolerated. Anything that disrupts the normal functioning of the brain can cause it.
Here are some of the main reasons:
- Severe infections: Especially urinary tract infections and lung infections (pneumonia) are the main causes of delirium in the elderly.
- Surgery: This condition can occur after major surgery, due to anesthesia and the stress on the body.
- Certain medications: Things like painkillers, sleeping pills, and some allergy medications can cause this condition, especially when you take several medications at the same time.
- Alcohol or drugs: Delirium can occur due to withdrawal symptoms that occur when someone who has been drinking heavily suddenly stops drinking.
- Dehydration and nutritional deficiencies: Decreased water content in the body and lack of necessary nutrition.
- Emergency medical conditions: Conditions such as a heart attack, stroke, or respiratory distress.
- Pain: Having severe, uncontrolled pain.
- Hospitalization: The hospital environment, where you are separated from your familiar environment, surrounded by strangers, and confined to bed with tubes in place, can cause delirium in some people.
- Constipation: Even severe constipation can sometimes be a cause of this.
Who is most likely to be affected by this?
Although delirium can occur in anyone of any age, some people are at higher risk.
- People over 65: They are more susceptible to changes in the brain and body as they age.
- People who already have a memory-related disease such as dementia.
- People who have previously experienced delirium.
- People with chronic diseases such as heart disease and lung disease.
- People with vision or hearing impairments (when not using glasses or hearing aids).
- People addicted to alcohol or drugs.
- People who use a large number of medications at the same time.
What are the possible complications of delirium?
If delirium is not treated promptly, it can lead to various complications. Some of these are temporary and some can be long-term.
- Falls and injuries: Confusion can lead to falling out of bed, falling while walking, and injuries such as broken bones.
- Bedsores: Staying in bed in the same position for a long time can cause skin sores.
- Aspiration Pneumonia: A severe pneumonia caused by food, drink, or saliva entering the lungs due to confusion.
- Malnutrition and dehydration: Just because you don't eat or drink.
- Long-term impairment of thinking ability (Cognitive impairment).
- New onset or worsening of dementia.
- Loss of ability to work independently.
How does a doctor recognize this?
There is no single test that specifically diagnoses delirium. The doctor makes the diagnosis by considering several factors together.
1. Asking about symptoms: Ask the patient and family for details about how these changes began and what symptoms they have. It is very important to know how sudden the change in the patient's behavior is.
2. Physical examination: The patient is thoroughly examined.
3. Neurological exam: Tests things like memory, thinking ability, and balance.
4. Tests: These tests are done to find the cause of delirium.
- Blood tests: Check for infections, electrolyte imbalances, kidney and liver function, etc.
- Urine tests: Check for urinary tract infections.
- Chest X-ray: To check for a condition like pneumonia.
- ECG test: Check the functioning of the heart.
- Brain scan: Only done if there is a suspicion of a condition such as a stroke.
How is it treated?
The main goal of treating delirium is to find and treat the underlying cause of the illness. For example, antibiotics are given if it is due to an infection. Saline is given if it is due to dehydration. When the cause is treated, the delirium condition gradually improves.
At the same time, supportive therapy is provided to provide comfort and ensure the patient's safety. While the medical staff does these things in the hospital, you can also do these things at home.
- Create a calm environment: Keep the patient's room quiet and calm. Dim the lights at night to create a comfortable sleeping environment.
- Provide good nutrition and fluids: Good nutrition is essential for the body to heal.
- Creating familiarity: Bring familiar items from home (pictures, blankets) and keep them around. The patient will find comfort in having family members talk to them frequently.
- Awareness of the world around them: Keep a large calendar and clock in a visible place. Always remind them what time it is and what day it is.
- Glasses and hearing aids: If the patient uses them, let them use them properly so that they do not lose contact with their surroundings.
- Move as much as possible: As advised by your doctor, walking around a bit and doing exercises that stretch your limbs are good for both your body and your mind.
Is there any special medicine for this condition?
There is currently no specific medication approved to treat delirium. However, in some cases, doctors use medication to control symptoms.
- Severe hyperactive delirium: If the patient is at risk of harming themselves or others, low doses of antipsychotics are given for a short period of time to reduce the agitation.
- Alcohol withdrawal symptoms: If delirium is caused by this, medications such as benzodiazepines are given.
- Infection: If it is a bacterial infection, antibiotics are given.
- At the end of life: Various medications are given to reduce pain and discomfort.
The most important thing is that all of these medications are given under the strict supervision of a doctor. You should never give any medication for this condition or change the dosage without medical advice.
Can delirium be prevented?
While it is not possible to completely prevent it, there are things we can do to reduce the risk. These are especially important if an elderly family member is going to be hospitalized.
- Good health habits: Keep your brain and body active. Get enough sleep. Stay social.
- Limit risky medications: Talk to your doctor and minimize the use of medications that can cause confusion.
- Be on the lookout for early signs: If you notice even the slightest change in behavior, especially in hospitalized patients, inform the doctor or nurse immediately.
- Educating family members: If there is someone at risk at home, it is important for everyone in the family to be aware of the symptoms of delirium.
Delirium can be a frightening experience for both the patient and their caregivers. It can be very distressing to see someone you love suddenly acting like a completely different person. But remember, in most cases, this is temporary . If the cause is identified and treatment is started early, the symptoms will improve. So the most important thing is to recognize these signs and seek medical advice as soon as possible.
Take-Home Message
- Delirium is not dementia. Rather than a slowly developing illness, it is a state of mental confusion that comes on suddenly over a period of hours or days .
- This is a medical emergency . If you notice symptoms, especially in an elderly person, see your doctor immediately or go to a hospital's Emergency Treatment Unit (ETU).
- The main part of treatment is treating the underlying condition that caused it . Delirium usually resolves when the underlying cause, such as infection or dehydration, is treated.
- As caregivers, providing a calm, familiar environment and keeping them aware of their surroundings is a great help in the healing process.
- Most cases of delirium are temporary and can be completely cured with proper treatment , so it's important to act quickly and not panic.
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