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Sharp Health News

Hospital delirium: a dire diagnosis for older patients

Oct. 16, 2017

Hospital delirium: a dire diagnosis for older patients

“Mom isn’t acting like herself.”

This brief statement to a nurse or doctor can be the first step in helping identify a common, often unrecognized complication of hospitalization: hospital delirium.

“Hospital delirium is a major issue facing hospitals today, especially with the aging population,” says Dr. Michael Plopper, chief medical officer of Sharp Behavioral Health Services. “It often goes unrecognized among elderly patients, and can be superficially assessed as dementia and therefore not properly treated.”

Close to one-third of all hospital patients over the age of 70 experience hospital delirium, a temporary but severe form of mental impairment caused by a variety of triggers. It often presents as rapid onset of confusion, shifting attention, incoherence, hallucinations, aggression or belligerence. Alternatively, it can appear as introversion and lethargy.

“Delirium is commonly caused by a medical condition, infection, or can follow surgery. Also the use of certain medications, or withdrawal from other habit-forming medications or alcohol, can produce delirium,” Dr. Plopper says. “If not properly identified and treated, it can lead to long-term negative consequences including medical complications, extended hospital stays, and increased risk of falls and greater medical costs.”

Dr. Plopper has witnessed and treated hospital delirium among patients. However, his understanding of the seriousness of the condition is rooted in far more than his medical education and practice — he too has experienced it.

While Dr. Plopper is only in his 60s, he experienced delirium when he was hospitalized for heart surgery and in the surgical intensive care unit for several days. He had unsettling hallucinations — troubling pictures on the walls and seemingly ill-tempered patients in other rooms, vivid imagery of things not really there — and asked a nurse about them.

“I expressed what I was experiencing and the nurse immediately recognized the signs of hospital delirium,” Dr. Plopper recalls. “She kindly reassured me and reoriented me to where I was and what was really around me, and the delirium resolved. However, not all cases are recognized as quickly or resolved so easily.”

According to Dr. Plopper, early identification and intervention are key to reducing the number of hospital delirium cases. Caregivers are becoming more aware of the prevalence of hospital delirium and are quick to mitigate related complications.

Hospital delirium can be treated or prevented by the judicious use of mediations; reduction of certain medications; a weaning from breathing machines; proper hydration and nutrition; quality sleep; physical movement; and ensuring patients are surrounded by familiar people and items with access to sensory aids, such as hearing devices, dentures, eyeglasses, a calendar and clock.

“It’s important for caregivers to take a good history from the family about when unusual behavior began and whether it worsened over a short time,” Dr. Plopper says. “It’s equally important for family members to speak up if their loved one is not behaving as they normally would. Hospital delirium is a great concern, and both the medical and general populations must be vigilant and responsive.”

For the news media: To talk with Dr. Michael Plopper about hospital delirium for an upcoming story, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.

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