Delirium is one of the 3 big ‘D’s that we see with our older clients. The other ‘D’’s are dementia and depression but I suppose the biggest ‘D’ out there is death.
I recently came across a Reader’s Digest article while waiting at a doctor’s office that had been reprinted from The Walrus. The original title is “Why Is No One Talking About Hospital-Acquired Delirium?’ The story describes a bright, on the ball 83 year old gentleman who was admitted to ER for a nose bleed. During the next few days at the hospital, he did not get much sleep and was disturbed by the noise, lights and activity and he was worried that the bleeding would return. He was sent home and 48 hours later, his wife called 911 as he was confused, restless and began hallucinating that he saw writing on the blank television screen. Back at ER, he was combative and swore at the staff. The doctors determined he had a magnesium deficiency and prescribed supplements. Upon returning for a follow up appointment they learnt that the confusion and mood swings were as a result of a hospital-acquired delirium.
I learnt that according to Dr. Gordon Boyd, neurologist at Queen’s University, that ‘hundreds of thousands of patients leave Canadian hospital with a newly acquired mental disorder caused in large part by inadequate care.’ A 2016 study reported that 15% of the 469 patients who were part of this study, developed delirium during their hospital stay. They reported that those patients had a ‘significantly increased’ risk of dying within ninety days of their admission- in part because of poor nutrition, disturbed sleep and the use of restraining devices.’
Delirium is often misdiagnosed as dementia ‘but delirium is an acute confused state, whereas dementia is a chronic condition characterized by memory loss.’ Also note that capacity may also be impaired if someone has delirium.
Dr. Boyd discussed that the system is working against itself. Seniors are admitted into hospital more than any other age group and usually stay longer and use more resources. This stay increases the likelihood that they will develop delirium, which means they are more likely to be readmitted. Furthermore once someone gets a diagnosis of delirium they remain more vulnerable.
I have often said that hospitals are not good places for sick people and besides the possibility of acquiring MRSA or C Difficile, delirium remains a real concern. On a positive note, some forward thinking hospitals are working to keep patients mobile, oriented, hydrated and rested thereby being able to reduce the chances of acquiring delirium by 40%.
Lesson Learnt: Remember Delirium as part of the 3 D’s and the ways to minimize its risk.