If you have ever noticed changes in cognition in yourself or in a loved one while in the hospital, it could have been hospital delirium. Bottom Line Personal spoke with Amanda Pomerantz, DO, assistant professor of psychiatry at University of Alabama at Birmingham and coauthor of an article to help doctors better recognize and manage hospital delirium.
What is hospital delirium?
Delirium is a sudden change in attention and awareness that waxes and wanes. Think of attention as the ability to focus on a task, for example, and awareness as knowing common things such as where you are and what time it is. Hospital delirium affects about 11% to 14% or more of hospitalized patients…those numbers are twice as high among geriatric patients and up to 82% of patients in the ICU.
Hospital delirium can happen to anybody, and it can take many forms, which is what makes it challenging to recognize and treat properly…
Hyperactive delirium symptoms include agitation, disorganized thinking, elevated or irritable mood, and increased or loud speech.
Hypoactive delirium symptoms include lethargy, difficulty staying awake, changes in mood and/or withdrawn behavior.
Mixed delirium features symptoms of both types.
Sometimes patients recognize signs of hospital delirium in themselves, but it’s often a family member who picks up on the changes. You might just feel as though your ability to think has slowed, it is harder to focus or you’re having difficulty with memory. Some people experience mood changes or hallucinations—seeing or hearing things that are not there.
Diagnosing hospital delirium is extremely important. On the surface, it can look like dementia because many patients have difficulty with memory, causing concern for patients and loved ones. Unlike dementia, most patients have improvement in symptoms as their medical condition improves, but delirium can result in longer-standing memory and thinking challenges for some patients. On the other hand, patients who have underlying dementia are at higher risk for developing delirium.
Why does hospital delirium happen?
While delirium often is a direct consequence of a medical illness, a medication or toxin, substance use or substance withdrawal, it often can have multiple causes. A urinary tract infection is a frequent cause for hospital delirium in older patients, but it also can be the result of many other things, such as a stroke, sedation for procedures, or medications like benzodiazepines, including lorazepam, alprazolam and diazepam, taken for anxiety, muscle spasms and seizures.
How to prevent hospital delirium
Certain interventions can help hospital patients avoid delirium…
Sleep. This sounds like mission impossible in the hospital, but try to maintain your sleep and wake cycles. Try to keep your hospital room bright during the day and as dark as possible at night to simulate the typical sleeping environment. Some hospitals offer earplugs and eye masks, which can help minimize disruptions. If you take a sleep aid such as melatonin at home, ask for it in the hospital. If possible, request that your nighttime care be bundled at night, with bloodwork, blood pressure checks and medications done at the same time, instead of your sleep being interrupted multiple times by different team members. This is harder to arrange in the ICU because that high level of care requires constant intervention, but often it is more feasible when on a general hospital floor.
Move as much as possible. Ask your nurse if it is safe for you to walk. If you are able, take regular trips through the hallways. Physical and occupational therapy, while hospitalized, are important to help stay active, strong and engaged.
Involve and empower your loved ones. Family members can have a positive impact by visiting often. Have them at your bedside as much as possible. Visits are opportunities to reorient hospitalized loved ones, remind them of where they are and why they are in the hospital. They can help advocate for the above care steps, be there to notice the changes brought on by delirium, and alert medical staff.
Also: Bring items from home, such as family photographs, to increase the patient’s comfort level. Bring any hearing aids and glasses (even if you take them home at night to prevent them getting lost or stolen)—these tools help keep patients engaged with their environment and functioning more or less as they would at home.
What is the treatment for hospital delirium?
There are no FDA-approved medications to treat delirium directly. Treating the underlying medical cause is the priority to resolve delirium. Some medications help with symptoms, such as antipsychotics for patients experiencing hyperactive or mixed delirium, but they all are used off-label. In the ICU, dexmedetomidine, a sedative administered through an IV drip, is frequently used to help with symptom relief.
Once home, if you notice any continuing challenges, whether it is with your memory or just the sense that you are not feeling 100% like yourself, talk to your doctor. You may be referred to a neuropsychologist or a psychiatrist as an outpatient for an evaluation.
