AC FFC Tidbit of the Week for January 8, 2023: Delirium May Look Different in Older Patients

About half of hospitalized older adults with dementia experience delirium. But delirium can be under-recognized by the healthcare team in acute care settings, especially if the patient has the hypoactive (or “quiet”) form of delirium.

When we picture someone who is experiencing delirium, we usually think of the hyperactive form that is characterized by hyper-alertness, restlessness, combativeness, resistance, and rambling. These patients get our attention. The hypoactive form is much different. Patients experiencing hypoactive delirium are more often drowsy, less coordinated, passive, and quiet. They are the “easy” or “good” patients, and their signs and symptoms can be missed more easily. This is dangerous since the effects of hypoactive delirium can be far-reaching.

Hypoactive delirium can result in marked functional decline (more than the hyperactive form), higher risk of infection, residual cognitive impairment, and a higher risk of death. These patients often have great difficulty when they return home because of a significant decline in function related to a lack of mobility and decreased participation in self-care while at the hospital.

By helping to identify patients suffering from hypoactive delirium early on and helping the patient to maintain their function, you can have a significant impact on their success when they leave the hospital.

Common causes of delirium:

  • Dehydration
  • Electrolyte imbalance
  • Lack of oxygen
  • Injury
  • Rule out psychiatric disorder
  • Infection
  • Urinary retention/unfamiliar environment
  • Medication

Another tip: Preventing delirium is easier than treating it. Things to try:

  • Cognitive stimulation
  • Improve sensory input (make sure they have their dentures, glasses, and hearing aids)
  • Mobilize, mobilize, mobilize!
  • Hydration and nutrition
  • Sleep hygiene
  • Avoid toxic medications

Have a great week!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s