Pop quiz: What aging health problem is extremely common, has serious implications for an older person’s health and wellbeing, and can often – but not always – be prevented?
It’s delirium. In my opinion, this is one of the most important aging health problems for older adults to be aware of. It’s also vital for family caregivers to know about this condition, since families can be integral to preventing and detecting delirium.
In this article, I’ll explain just what delirium is, and how it compares to dementia. Then I’ll share 10 things you should know, and what you can do.
What is Delirium
Delirium is a state of worse-than-usual mental confusion, brought on by some type of unusual stress on the body or mind. It’s sometimes referred to as an “acute confusional state,” because it develops fairly quickly (e.g., over hours to days), whereas mental confusion due to Alzheimer’s or another dementia usually develops over a long time.
The key symptom of delirium is that the person develops difficulty focusing or paying attention. Delirium also often causes a variety of other cognitive symptoms, such as memory problems, language problems, disorientation, or even vivid hallucinations. In most cases, the symptoms “fluctuate,” with the person appearing better at certain times and worse at other times, especially later in the day.
Delirium is usually triggered by a medical illness, or by the stress of hospitalization, especially if the hospitalization includes surgery and anesthesia. However, in people who have especially vulnerable brains (such as those with Alzheimer’s or another dementia), delirium can be provoked by medication side-effects or less severe illnesses.
It’s much more common than many people realize: about 30% of older adults experience delirium at some point during a hospitalization.
That confusion after surgery that older adults often experience? That’s delirium.
The way your elderly mother with dementia gets twice as confused when she has a urinary tract infection? That’s delirium too.
Or the common phenomenon of “ICU psychosis”? That too is delirium.
What Causes Delirium?
In older adults, delirium often has multiple causes and contributors. These can include:
- Infection (including UTI, pneumonia, the flu, COVID)
- Other serious medical illness (e.g. heart attack, kidney failure, stroke, and more)
- Metabolic imbalances (e.g. abnormal blood levels of sodium, calcium, or other electrolytes)
- Dehydration
- Medication side-effects
- Sleep deprivation
- Uncontrolled pain
- Sensory impairment (e.g. poor vision and hearing, which can worsen if the person is lacking their usual glasses or hearing aids)
- Alcohol withdrawal
Delirium vs. Dementia
People often confuse delirium and dementia (such as Alzheimer’s disease), because both conditions cause confusion and appear superficially similar. Furthermore, people with dementia are actually quite prone to develop delirium. That’s because delirium is basically a reflection of the brain going haywire when it gets overloaded by the stress of illness or toxins, and brains with dementia get overloaded more easily.
In fact, the more vulnerable a person’s brain is, the less it takes to tip them into delirium. So a younger person generally has to be very very sick to become delirious. But a frail older person with Alzheimer’s might become delirious just from being stressed and sleep-deprived while in the hospital.
Why Delirium is Such an Important Problem
There are three major reasons why delirium is an important problem for us all to prevent, detect, and manage.
First, delirium is a sign of illness or stress on the body and mind. So if a person becomes delirious, it’s important to identify the underlying problems – such as an infection or untreated pain – and correct them, so that the person can heal and improve.
The second reason delirium is important is that a confused person is at higher risk for falls and injuries during the period of delirium.
The third reason is that delirium often causes serious consequences related to health and well-being.
In the short-term, delirium increases the length of hospital stays, and has been linked to a higher chance of dying during hospitalization. In the longer-term, delirium has been linked to worse health outcomes, such as declines in independence, and even acceleration of cognitive decline.
Now let’s cover 10 more important facts you should know about delirium, especially if you’re concerned about an aging parent or other older relative.
10 Things to Know About Delirium, and What You Can Do
1.Delirium is extremely common in aging adults.
Almost a third of adults aged 65 and older experience delirium at some point during a hospitalization, with delirium being even more common in the intensive care unit, where it’s been found to affect 70% of patients. Delirium is also common in rehabilitation units, with one study finding that 16% of patients were experiencing delirium.
Delirium is less common in the outpatient setting (e.g. home, assisted-living, or primary care office). But it still can occur when an older adults gets sick or is affected by medications, especially if the person has a dementia such as Alzheimer’s.
What to do: Learn about delirium, so that you can help your parent reduce the risk, get help quickly if needed, and better understand what to expect if your parent does develop delirium. You should be especially be prepared to spot delirium if your parent or loved one is hospitalized, or has a dementia diagnosis. Don’t assume this is a rare problem that probably won’t affect your family. For more on hospital delirium, see Hospital Delirium: What to know & do.
2. Delirium can make a person quieter.
Although people often think of delirium meaning as a state of agitation and or restlessness, many older delirious people get quieter instead. This is called hypoactive delirium. It’s still linked with difficulty focusing attention, fluctuating symptoms, and worse than usual thinking. It’s also linked with poor outcomes. But it’s of course harder for people to notice, since there’s little “raving” or restlessness to catch people’s attention.
What to do: Be alert to those signs of difficulty focusing and worse-than-usual confusion, even if your parent seems quiet and isn’t agitated. Tell the hospital staff if you think your parent may be having hypoactive delirium. In the hospital, it’s normal for older patients to be tired. It’s not normal for them to have a lot more difficulty than usual making sense of what you say to them.
3. Delirium is often missed by hospital staff.
Despite the fact that delirium is extremely common, it is often missed in hospitalized older adults, with some reports estimating it’s being missed 70% of the time. That’s because busy hospital staff will have trouble realizing that an older person’s confusion is new or worse-than-usual. This is especially true for people who either look quite old – in which case hospital staff may assume the person has Alzheimer’s – or have a diagnosis of dementia in their chart.
What to do: You must be prepared to speak up if you notice that your parent isn’t in his or her usual state of mind. Hypoactive delirium is especially easy for hospital staff to miss. Hospitals are trying to improve delirium prevention and detection, but we all benefit when families help out. Remember, no hospital person knows your parent the way that you do.
4. Delirium can be the only outward sign of a potentially life-threatening problem.
Although delirium can be brought on or worsened by “little things” such as sleep deprivation or untreated constipation, it can also be a sign of a very serious medical problem. For instance, older adults have been known to become delirious in response to urinary tract infections, pneumonia, and heart attacks.
In general, it tends to be older persons with dementia who are most likely to show delirium as the only outward symptom of a very serious medical illness. But whether or not your older relative has dementia, if you notice delirium, you’ll want to get a medical evaluation as soon as possible.
What to do: Again, if you notice new or worse-than-usual mental functioning, you must bring it up and get your parent medically evaluated without delay. For older adults who are at home or in assisted -living, you should call the primary care doctor’s office, so that a nurse or doctor can help you determine whether you need an urgent care visit versus an emergency room evaluation.
5. Delirium often has multiple underlying causes.
In older adults with delirium, we often end up identifying several problems that collectively might be overwhelming an older person’s mental resilience. Along with serious medical illnesses, common contributors/causes for delirium include medication side-effects (especially medications that are sedating or affect brain function), anesthesia, blood electrolyte imbalances, sleep deprivation, lack of hearing aids and glasses, and uncontrolled pain or constipation. Substance abuse or withdrawal can also provoke delirium.
What to do: To prevent delirium, learn about common contributors and try to avoid them or manage them proactively. For instance, if you have a choice regarding where to hospitalize your parent, some hospitals have “acute care for elders” units that try to minimize sleep deprivation and other hospital-related stressors. If your parent does develop delirium, realize that there is often not a single “smoking gun” when it comes to delirium. A good delirium evaluation will attempt to identify and correct as many factors as possible.
6. Delirium is diagnosed by clinical evaluation.
To diagnose delirium, a doctor first has to notice – or be alerted to – the fact that a person may not be in his or her usual state of mind. Experts recommend that doctors then use the Confusion Assessment Method (CAM), which describes four features that doctors must assess. Delirium can be diagnosed if a patient’s symptoms include “acute onset and fluctuating course,” “difficulty paying attention,” and then either “disorganized thinking” or “altered level of consciousness.”
Delirium cannot be diagnosed by lab tests or scans. However, if an older adult is diagnosed with delirium, doctors generally should order tests and review medications, in order to identify factors that have caused or worsened the delirium.
What to do: Again, the most important thing for you to do is to get help for your loved one if you notice worse-than-usual confusion or difficulty focusing. Although families have historically not had a major role in delirium diagnosis, delirium experts have developed a family version of the CAM (FAM-CAM), which is designed for non-clinicians and has been shown to help detect delirium.
7. Delirium is treated by identifying and reversing triggers, and providing supportive care.
Delirium treatment requires a care team to take a three-pronged approach.
- Health providers must identify and reverse the illness or problems provoking the delirium.
- They have to manage any agitation or restless behavior, which can be tricky since a fair number of sedating medications can worsen delirium.
- The safest approach is a reassuring presence (family is best, but hospitals sometimes also provide a “sitter”) to be with the person, plus improve the environment if possible (e.g. a room with a window and natural light).
- The once-popular practice of physically restraining agitated older adults has been shown to sometimes worsen delirium, and should be avoided if possible.
- The care team needs to provide general supportive care to help the brain and body recover.
What to do: The reassuring presence of family is often key to providing a supportive environment that promotes delirium recovery. You can also help by making sure your loved one has glasses and hearing aids, and by alerting the doctors if you notice pain or constipation. Ask the clinical team how you can assist, if restlessness or agitation are an issue. Bear in mind that physical restraints should be avoided, as there are generally safer ways to manage agitation in delirium.
8. It can take older adults a long time to fully recover from delirium.
Most people are noticeably better within a few days, once the delirium triggers have been addressed. But it can take weeks, or even months, for some aging adults to fully recover.
For instance, a study of older heart surgery patients found that delirium occurred in 46% of the patients. After 6 months, 40% of those who had developed delirium still hadn’t recovered to their pre-hospital cognitive abilities.
What to do: If your parent or someone you love is diagnosed with delirium, don’t be surprised if it takes quite a while for him or her to fully recover. It’s good to be prepared to offer extra help during this period of time. You can facilitate recovery by creating a restful recuperation environment that minimizes mental stress and promotes physical well-being.
9. Delirium has been associated with accelerated cognitive decline and with developing dementia.
This is unfortunate, but true, especially in people who already have Alzheimer’s or another type of dementia. A 2009 study found that in such persons, delirium during hospitalization is linked to a much faster cognitive decline in the following year. A 2012 study reached similar conclusions, estimating that cognition declined about twice as quickly after delirium in the hospital.
In older adults who don’t have dementia, studies have found that delirium increases the risk of later developing dementia.
What to do: Experts aren’t sure what can be done to counter this unfortunate consequence of delirium, other than to try to optimize brain well-being in general. (For this, I suggest avoiding risky medications, getting enough exercise and sleep, being socially and intellectually active, and avoiding future delirium if possible.)
The main thing to know is that delirium has serious consequences, so it’s often worth it for a family to be careful about surgery in an older person, and it’s good to learn about delirium prevention (see below).
10. Delirium is preventable, although not all cases can be prevented.
Experts estimate that delirium is preventable in about 40% of cases. Preventive strategies are meant to reduce stress and strain on an older person, and also try to minimize delirium triggers, such as uncontrolled pain or risky medications.
In the hospital setting, programs such as the Hospital Elder Life Program (HELP) for Prevention of Delirium have been shown to work. For ideas on how families can help, see this family tip sheet from the Hospital Elder Life Program. For instance, families can help reorient a relative in the hospital, ensure that glasses and hearing aids are available, and provide a reassuring presence to counter the stress of the hospital setting.
Less is known about preventing delirium in the home setting. However, since taking anticholinergic medications (such as sedating antihistamines) has been linked with hospitalizations for confusion, you can probably prevent delirium by learning to spot risky medications your parent might be taking.
What to do: To prevent hospital delirium, carefully weigh the risks and benefits before proceeding with elective surgery. If your parent must be hospitalized, choose a facility using the HELP program or with an Acute Care for Elders unit if possible. Be sure to read HELP’s tips for families on preventing hospital delirium.
Remember, delirium is common and can be the only outward sign of a serious medical problem.
By educating yourself and helping your older loved ones be proactive about prevention, you can reduce the chance of harm from this condition.
And if you do notice symptoms of delirium, make sure to tell the doctors! This will help your parent get the evaluation and treatment that he or she needs.
Useful Online Resources Related to Delirium
Here are links to some of the resources I reference in the article:
- A study (one of many) finding that delirium is linked to worse health outcomes in the elderly
- A study of older adults in the Intensive Care Unit, finding that 43.5% had hypoactive delirium
- An article finding that older patients do better when they are hospitalized in an “Acute Care for Elders” unit (a special hospital ward tailored towards protecting older adults from hospital complications; they are great!)
- An explanation of the Confusion Assessment Method, which experts recommend doctors use to diagnose delirium
- A description of the Family-CAM, which experts developed to help family caregivers detect delirium
- A study finding that delirium accelerates cognitive decline in Alzheimer’s; a follow-up study finding that people with dementia decline twice as quickly after having delirium (!) is here.
- Tips on how family caregivers can prevent delirium, from the Hospital Elder Life Program
Last but not least, for my previous posts on delirium:
- Delirium: How Caregivers Can Protect Alzheimer’s Patients
- Hospital Delirium: What to Know and Do
- How to Maintain Brain Health: the IOM Report on Cognitive Aging
If you have any additional questions regarding delirium, please post them below!
This article was first written by Dr. Kernisan in July 2015, and was reviewed and updated in August 2023.
Anna says
Hi there, my mother is currently in hospital with suspected delirium. But of background information, my mother is 74 years old. She had lung surgery on 14th of Feb for treatment of lung cancer. She ended up staying in hospital for over 3 weeks. There were minor setbacks with her bladder control plus her drain port leaked but these all rectified themselves before discharge. She had been on strong pain relief but had been weaned off these and was on paracetamol only for pain when she was sent home. She came home on Tuesday the 8th of March and the first few nights, she was having vivid dreams and was disorientated. She thought she was still in the hospital. We thought she was just settling back in. Her mood was quite low too. She ended up visiting her GP on the Thursday as she was shaking and kept drifting off. Her blood pressure was high and he prescribed a short term course of medication for this. She is already on medication for BP and a heart arrhythmia. I visited her on the Friday and while her mood was still low, she was brighter in herself and I thought she was starting to come round. On Saturday morning when I spoke to her on the phone she was all muddled and started talking pure nonsense. She ended up being readmitted to hospital where chest xray, head ct and bloods have all been done and are fine. She us currently awaiting brain mri. I was with her all day Saturday and was able to visit her on Sunday and Monday. She is not herself at all. She has a vacant look on her face and was talking utter nonsense, speaking about things that never happened. Not engaging in conversation at all and very few moments of clarity. One of the doctors who she met with regards to her lung problems rang me on Wednesday to say they thought she was having a delirium. I was able to visit again in Friday even though no visitors are allowed due to covid outbreak in the hospital. The nurse said she had an episode during the night where she stood straight up and was rigid. They don’t think it was a seizure. She was lying in the bed with her eyes closed and was shaking. She didn’t even register I was there and just wasn’t like my mother at all. She was completely different today than when I last saw her. The ward sister I spoke to mentioned dementia but she had zero signs of dementia previously and was an extremely independent capable lady. I just can’t equate the person in hospital with my mother. This has been like a bolt of lightning. My mother was admitted to hospital in mid December due to fainting and this is when the discovery of growths on her lungs was discovered and cancer subsequently diagnosed. Between this and her worry about the surgery that took place she was fairly stressed but she was still herself. This waiting for brain mri is a killer because they won’t look at any other possibilities until they’ve ruled out a medical reason for it. The ward sister I met on Friday said she doesn’t think it’s delirium and mentioned dementia. On Friday night she spiked a temperature and is on IV antibiotics now fortunately. Urine sample has been sent off again and head ct repeated which was clear. Today she had to be fully assisted whilst having her breakfast. The change in her even since she’s been admitted is huge. She was able to feed herself no problem. Its awful.
Nicole Didyk, MD says
I’m so sorry to hear about your mother’s experience, what an ordeal for her and your family.
You’re describing delirium very well, although everyone has a different course. It’s not unusual that the diagnosis of dementia gets raised when a person is in a delirium, but there’s a big difference. I made a YouTube video about that which you can watch here: https://youtu.be/uKp3sGwk4Tc
Remember that delirium can take a longer time than you’d expect to get better, even months, and in some cases, the person is not quite fully back to their previous baseline. I hope that in your mom’s case, she can make a full recovery, and I’m glad you can visit her. Those visits are likely to help her feel like her self again.
Tom Bailey says
My 72 year old wife had a kidney removed because of cancer when she was 70. Everything went well. Then She was diagnosed with lymph node cancer a few months ago and had 5 bouts of radiation. During this time she had bad pain in her stomach which was diagnosed has a tear in her abdomen which was leaking gas and air into her stomach. Successful surgery was done and she is in recovery, but she does not move at all after 5 days. She won’t get up for rehabilitation and says she wants to die and is fed up with everybody. She was a strong women and we have been married 54 years and I don’t understand her behaviour. Thanks
Nicole Didyk, MD says
I’m sorry to hear about the tough time your wife has had, it sounds like a really rotten past few months for both of you.
Delirium is common in older adults after surgery, and can interfere with a person’s motivation to do rehab. It usually also causes lapses in attention or alertness, fluctuations, and even hallucinations, and can take weeks or even months to completely resolve.
When I hear about someone saying they’re fed up and want to die, I think about depression, and you can read my article about that here, or watch my video on YouTube. Depression is more common in those with medical issues, like cancer or chronic pain. It’s treatable with counselling, cognitive behavioral therapy, and medication, but needs to be diagnosed first. A depression might explain the symptoms you’re observing, and I would suggest asking her doctor about it.
Brad says
I’ll add to all the stories. My father was 94 at the time he passed out and fell at home. This is 12/31/2019. It was discovered that he had a tumor in his abdomen that eventually burst in his intestine and required major emergency surgery to save his life. Needless to say, this was a major trauma on his body not to mention all the drugs for the surgery and post surgical recovery. Long story short, he got hospital delirium while at the hospital and it continued during his 4-week stay at a skilled nursing facility during his recover. We finally go him home mid-March, 2020 which he still had delirium.
Almost immediately he began to get more clear minded once in familiar surroundings. However, he never recovered to his pre-2019 cognition level. He had good days and bad days. And early on, his good days outnumbered his bad days. But more recently his bad days have outnumbered his good days. He is confused most of the day and hallucinates frequently.
It is now June, 2021. He will be 96 in July and he has slipped into dementia and pretty much everyday is an adventure with us. You never know what you will get each day. He sleeps and dreams. And many time, he wakes up still believing his dream state.
Initially, during the delirium onset, we tried to connect his misconception did our best to ground him back to reality and keep him calm. Now with dementia, we just go with the flow and try not to correct him because when we do we tend to agitate him.
It’s been a tough year and a half for us and we don’t hold any hope of getting our patriarch back. Our goal now is to keep him comfortable at home for as long as we can.
Nicole Didyk, MD says
Thanks for adding your voice to the conversation, and I’m sorry to hear about all the challenges you’ve faced as a family.
A fall like the one you describe is commonly the beginning of a cascade of diagnoses and interventions, sometimes resulting in irreversible changes. The “good days” that you mention can be a real blessing, and often the goals of medical care shift to promote more of those good days rather than achieve a cure or return to prior function, and that’s OK, and usually more realistic.
It’s wonderful that your dad has a loving and supportive family, and that you’re so resourceful and adaptable as you see changes happen. I made a video about how to communicate with older adults with dementia which you might find interesting. You can watch it here: https://youtu.be/N0haz51Ll9s
Deborah Yee Litt says
Dr. Didyk,
First, thank you for this excellent resource and your public service. My 88 year-old mother just returned to our home (where she resides) from a 6 week stay in a rehab facility. The initial 3 days home were uneventful but now her early morning delirium is affecting her sleep; to compound matters, she has always had PTSD from WWII which is resurfacing once again. I can deal with the delirium but I am wondering if we should seek an alternative to Tramadol (used with her Tylenol) for pain management so she can do PT and sleep through the night without pain (and, ironically, I read above that pain contributes to delirium!). She also has started Allegra (low anticholinergic) and is given Trazadone PRN when she cannot sleep. She has also been started on Aricept at bedtime. My question to you is how much are these new meds contributing to her delirium and should the dosing be at another time than bedtime? She wears an external catheter at night so does not ambulate to the bathroom (reduces fall risk). She has been on Cymbalta bid for myalgia and underlying depression as well as Diltiazem, metoprolol and telmisartan for several years.
Thank you for your time.
Nicole Didyk, MD says
I’m glad your mom is back home. It’s not unusual for older adults to be on a slew of new medications when discharged from hospital, and they may not all be meant to be used long term.
I usually administer Aricept in the morning, as it can cause a bit of activation and may also contribute to nightmares.
Pain is tricky to treat in the setting of a delirium, and non-medication treatments might be preferable (like massage, heat, ultrasound, acupuncture and physiotherapy). Cymbalta can have pain relieving properties as well, so this might be reasonable to review and see if the dose is optimal.
I also use melatonin for sleep instead of trazadone, which seems to cause less of a lingering “hangover” the next day.
A pharmacist can be a great resource when trying to sort out medications in an older adult, and I often collaborate with pharmacists to review a medication list.
Finally, an external catheter is less likely to cause infection than one that is connected to the bladder, but it can be worth checking for a UTI if new behavior changes occur.
Jayne Brien says
Hello, thank you for your article. Our 93 year old Mum has been doing really well until early last year when she started taking opioid pain relief and nerve blockers for arthritis and referred leg pain, and also developed a chronic venous leg ulcer. A terrible rash developed, followed by the start of delusions of infestation/parasitosis.
She doesn’t have dementia, but the description of delirium fits with a rapid decline we’ve seen in her over the past two months. She has been taking 5mg of Aripiprazole daily since late last year for the delusions, but they haven’t subsided, they seem worse, interrupt her sleep, cause her to damage her skin and generally distress her. We’ve tried numerous pain meds, Tapentadol seems the best tolerated. She’s started seeing people in her home, deceased family members and strangers, while dreaming and awake. Her psychiatrist wants to up the Aripiprazole dose, we want to stop it to see if it’s causing this decline, he thinks her worsening cognitive state is due to decreased blood perfusion in her brain. We’re very concerned as she lives alone, by her own very firm choice, with daily nursing (for leg ulcer) and family support. Next step is hypnosis and another geriatrician, the first one touted her rash as “abuse” before she’d even started gathering information regarding mum’s care/living situation. Very distressing times.
Nicole Didyk, MD says
Hi Jayne, I’m glad the article was helpful.
It sounds like your mum has really suffered with pain and medication side effects. I wouldn’t be surprised if delirium occurred in a situation like the one you describe. It does sound as though your mom has support from nursing and her psychiatrist, and that’s reassuring.
It’s so hard to know if a medication should be stopped, to see if it’s causing the symptoms, or if it should be increased to see if they help with the hallucinations – this is a dilemma that I’ve grappled with many times! What can be very helpful is trying to get some objective data on how the behaviors and symptoms change in response to the medication adjustments. Keeping a calendar with notes about what’s happening from day to day can be a great guide to what to do.
I’ve never used hypnosis in a delirium scenario but it’s an interesting idea.
Another piece is to look after yourselves while caring for your mom and trying to respect her wish to stay at home. As you’ve likely experienced, this can be a long journey.
Laurie C. says
Hello Dr. Kernisan,
Thank you so much for this information. It’s so important. I really appreciate all of your articles. I just wanted to make the readers aware of what happened to my mom. She’s only 74yo-over night-became very delirious-couldn’t focus on anything, couldn’t play games anymore, couldn’t read the paper. Had to help her get dressed. It was awful. The doctor would not listen to me that she was perfectly fine the week before. He told me she had vascular dementia. Long story short-turns out it was a combo of Cymbalta which a Neurologist gave her for her migraines and took her off cold turkey on her Effexor which she had been taking with no problems for years. It really messed her up. She practically became a vegetable. All of the medical people didn’t understand or listen. The other neurologist we saw wanted to put a shunt in her brain. We got her off the Cymbalta. We found out she also had an acute UTI that turned into a Kidney Infection-she showed no symptoms except cognitively. She started slurring her words and babbling. She slid to the floor and we couldn’t get her to move or get up. She was like a rag doll. They put her in the Hospital and gave her an IV antibiotic and she was finally on the mend. Today, a year later-she is back to herself and can read, watch TV, and play games with me. So, if your parent becomes delirious overnight, definitely look at the medication and check for a UTI. I looked up Cymbalta and it is known to cause this problem with older people. Why didn’t the Neurologist tell us this?? Very upset and hard to trust doctors anymore. I hope we never have to go through this again but will be wiser the next time. Patients-stand up for yourself. Keep fighting when you know something is wrong.
Nicole Didyk, MD says
Thanks for sharing your story, and I’m so sorry you and your family went through that. How wonderful that your mom is back to herself again.
It’s common to hear of how concerns are dismissed as “just getting old” or as “nothing new” and that can lead to delays of diagnosis and correct treatment, as well as the suffering you describe. Your point about advocacy and not giving up is spot on! It’s a constant fight against ageism, ableism, sexism and the constraints of an overburdened health care system. Looking at medications as a cause for new symptoms is a Geriatric must-do.
Hearing that the information on Dr. K’s website is so gratifying and means the world.
Norma D Linn says
Could you please provide a printable version of your articles? I like to print them and keep as references and it’s much easier to read and study than sitting at my computer, especially given I’m taking care of my husband with Parkinson’s.
Thank you.
Nicole Didyk, MD says
Hi Norma and glad you like the article. If you scroll down to the very bottom, there’s a little green printer icon that you can click on to get to the printable article.
Donna says
Hi, my Mom has not officially been diagnosed (refuses testing) but has a dementia of some kind, most likely vascular. Some days are better than other days as far as her abilities and speech. I have noticed that the day after she eats sugar her cognitive abilities are diminished. Have you ever experienced this? She normally drinks a boost everyday, two if I do not see her. Yesterday we went out to celebrate and each got a 20 oz chocolate shake. Today she did not know how to get dressed (she always dresses herself) and has been confused all day.
Additionally, over the last few days I have noticed that she has been subdued, somewhat withdrawn and more confused than usual. Her sleep is irregular and she fights going to bed, going to sleep so she doesn’t get the quality nor quantity of sleep she should. Could this be delirium also?
So, my two questions are: can sugar affect cognition and could my Mom be experiencing delirium also?
Thanks so much for any help you can provide me.
Sincerely, Donna
Nicole Didyk, MD says
Hi Donna. Those are good questions.
There’s no good evidence that sugar intake causes short term effects on cognitive performance in dementia, but it can cause a short-term energy boost, followed by a “crash” which can cause fatigue and “brain fog” type symptoms. This usually lasts hours though, not days.
Delirium is marked by a change in level of alertness, concentration, attention and even level of consciousness (with drowsiness or hypervigilance), so it’s hard to tell if the changes you describe fit this pattern. It’s typical for people living with dementia to have days when things go better than others, just like in those who are not living with dementia. Having had a poor sleep can definitely increase the likelihood of a “bad day” .
It can be helpful to keep notes of a person’s activity, sleep and diet patterns to see if they correlate with changes in behaviour, or if it’s just a coincidence.
Gretchen Brauer-Rieke says
The inability to stay with our elder loved ones while hospitalized during the COVID pandemic has been a huge disruption in our ability to minimize delirium. We helplessly remain outside while our hospitalized loved ones move further into confusion to the point that they often can’t even use digital communication to connect with us. It was a disaster for my father (age 91) after he fell and broke his pelvis – both at hospital ER (where we weren’t allowed to come in and assist with decision-making, even though he has documented dementia) and the rehab center, where we couldn’t see him. After just days, he was so confused that he had no idea where he was or why, and we finally ended up pulling him out on hospice care to die at home. He was able to re-orient once we got him home and cared for him ourselves, but it was a hard journey to that peaceful death.
Nicole Didyk, MD says
Gretchen, I’m so sorry that your father went through that experience, and I’m so glad he was able to return home for the last part of his life. I sincerely hope that we take a long hard look at the consequences of isolation and separation balanced against the risks of infection, before the next crisis comes.
It can be traumatizing to see a family member go through delirium so I hope you’re getting the support you need.
Gail Mainiero says
My 91 year old mom has been officially diagnosed with Alzheimers two years ago. I am certain she had it several years before I brought her to a specialist. She now lives with me and has for about 1.5 years. She has had 3 UTI’s which as soon as I detected and got her treated the delirium seemed to clear in about 1 day. Recently she was in the hospital for very mild fluid in one lung and possible UTI (not sure if it was never really cleared up or if it was new. Now home for over two weeks and a sudden onset of delirium and massive confusion. I brought her to urgent care and everything came out fine. Great vitals, no UTI and chest xray clear. Today she didnt know me and I played her dead sister for most of the day as that seemed to calm her. Her doctor did prescribe 5mg of Adavan (they gave that to her on one night in the hospitaL) her doctor was reluctant but understood that it was important since she got up 3x in one night and tried to use my stove. I have now been referred to a psychiatrist for management of her meds. Can this delirium just go away? I fear this will be the difference between caring for her at home or in a home.
Nicole Didyk, MD says
That sounds like a really difficult situation and I’m sorry your mom has had a tough time.
Delirium can take a while to improve, days or even weeks or longer. And it can wax and wane as you describe. There’s no magic bullet medication that clears it up and unfortunately, benzodiazepines like ativan (lorazepam) can cause more confusion and sedation, although it can seem to relax the person and promote sleep. It’s not a good idea to use ativan on a long term basis.
A psychiatrist with expertise in Geriatrics should be able to provide some guidance with respect to medications, but often it takes time and routine to see the delirium clear.