“How should delirium be managed in the hospital?”
This question came up during a Q & A session, as we were discussing the Choosing Wisely recommendation to avoid tying down older adults who become confused during a hospitalization.
Delirium is a common and very important problem for all older adults in the hospital. It doesn’t just happen to people with Alzheimer’s or a dementia diagnosis. (And, it’s not the same thing.)
But many family caregivers have hardly heard of hospital delirium. This is too bad, since there’s a lot that family caregivers can do to prevent this serious complication, or at least prevent an older loved one from being physically restrained if delirium does occur.
In this post, I’ll review what older adults and families absolutely should know about hospital delirium. And, we’ll cover some of the things you can do if it happens to your loved one.
Why hospital delirium is so important to know about
Delirium is a state of worse-than-usual mental function, brought on by illness or some kind of stress on the body or mind.
It is sometimes referred to as “hospital confusion” or “hospital sundowning.” And if it happens in the intensive care unit (ICU), it is sometimes referred to as “ICU psychosis.”
Although people with dementia are especially prone to develop delirium, delirium can and does affect many aging adults who don’t have Alzheimer’s or another dementia diagnosis. Here are some facts that all older adults and family caregivers should know:
- Delirium is very common during hospitalization. Delirium can affect up to half of older patients in a hospital. Risk factors include having pre-existing dementia and undergoing surgery. Having had delirium in the past is also a strong risk factor.
- Delirium is strongly associated with worse health outcomes. Short-term problems linked to delirium include falls and longer hospital stays. Longer-term consequences can include speeding up cognitive decline, and a higher chance of dying within the following year.
- Delirium is often missed by hospital staff. Busy hospital staff may not realize that an older person is more confused than usual, especially if the delirium is of the “quiet” type. (Although many people are restless when delirious, it’s also common for people to become quiet and “spaced out.”)
- Delirium is multifactorial. There often isn’t a single cause for delirium. Instead, it tends to happen due to a combination of triggers (illness, pain, medication side-effects) and risk factors (dementia, or pre-dementia). This means that treatment — and prevention — often require a multi-pronged approach.
To summarize, delirium is common, serious, and often missed by hospital staff.
Fortunately, there’s a lot that you can do as a family caregiver. In particular, you can help your loved one more safely get through a hospitalization by:
- Taking steps to prevent delirium;
- Keeping an eye out for any new or worse-than-usual mental states that might signal delirium;
- Making sure hospital staff address the problem if it does happen;
- Questioning things if the hospital resorts to tying a person down, before all other options have been tried. (This last one is a Choosing Wisely recommendation.)
How to prevent hospital delirium
Now, not all hospital delirium can be prevented. Some people are very sick, or very prone to delirium, and it’s certainly possible to develop delirium even when all triggers and risk factors have been addressed. Furthermore, many older adults are already delirious when they first get hospitalized.
Still, there are steps that can be taken to reduce the chance of a bad delirium. Experts estimate that about 40% of delirium cases are preventable.
The ideal is to be hospitalized in a facility that has already set up a multi-disciplinary delirium prevention approach, such as the Hospital Elder Life Program. Other hospitals have Acute Care for Elders units (also called “ACE” units) which also provide a special environment meant to minimize the hospital stressors that can tip an older person into delirium.
For elective surgeries, such as joint replacements, look for a hospital that has set up a geriatric co-management program for orthopedics, such as this one.
Here are some specific interventions that help reduce delirium, and how you can help as a caregiver:
- Minimize sleep deprivation. Consider asking the nurses if it’s possible to avoid blood pressure checks in the middle of the night. A quieter room can help. Do NOT ask for sleeping pills, however! Even a mild sedative, such as diphenhydramine (brand name Benadryl) increases the risk of developing delirium. Sleeping pills can also make delirium worse in someone who is already affected.
- Minimize vision and hearing impairments. Make sure the older person has glasses and hearing aids available, if they usually need them.
- Provide familiar objects and reassuring companionship. A few family photos can bring some soothing cheer to an older person’s hospital stay. Family or friends at bedside are also often very helpful, especially since they can help gently reorient an older person to where he is, and what’s been going on.
- Avoid overwhelming or overstimulating the person. Try to minimize mental strain or emotional stress for the person. A calm reassuring presence is ideal. If you need to give instructions or discuss something, try to keep things simple.
- Encourage physical activity and mobilization. Although many older people are sick or weak while in the hospital, it’s important to encourage safe activity as soon as possible. Physical therapy and minimizing bladder catheters (which can tether an older person to the bed) can help.
- Avoid sedatives and tranquilizers. Especially if the older person is restless or having difficulty sleeping, it’s not uncommon for sedatives such as diphenhydramine (brand name Benadryl) to be prescribed. But these can increase the risk of delirium, and should be avoided. So instead, try non-drug relaxation therapies such as soothing music, massage, a cup of tea, and familiar companionship.
- Minimize pain and discomforts. Ask the older person if he or she feels bothered by pain or constipation. If so, bring it up to the doctors. It’s not uncommon for pain to go inadequately treated unless family caregivers help an older patient bring it to the doctors’ attention.
If you think your loved one has developed delirium, make sure the doctors and nurses know about it. You may want to ask them what their plan is for evaluating and managing it. This will help you stay up-to-speed on the hospital course.
Some hospitals may even interview families to help diagnose delirium, using something called the FAM-CAM (short for Family Confusion Assessment Method) tool. The Confusion Assessment Method is generally considered the gold standard for diagnosing delirium.
Common causes of hospital delirium
Here are some common causes and triggers of hospital delirium and of “sundowning” symptoms when an older person is in the hospital. (Remember: in most older adults, multiple underlying causes and triggers are present.)
- Blood electrolyte imbalances (e.g. blood sodium being too high or too low)
- Infections, such as pneumonia, sepsis (bacteria in the bloodstream), and urinary tract infections
- General anesthesia and/or surgery
- Dehydration
- Drug toxicities and medication side-effects
- Withdrawal from alcohol, sedatives, or other drugs
- Blood glucose being too high or too low
- Sleep deprivation
- Kidney or liver problems
- Untreated pain or constipation
In people who have Alzheimer’s or another form of dementia, just the stress and unfamiliarity of the hospital setting can be enough to tip them into increased confusion.
Sensory impairments, such as uncorrected vision or hearing, can also help tip a vulnerable older person into delirium.
How hospital delirium is treated
To treat delirium, here’s what the doctors and nurses usually do:
- Identify and reverse as many triggers as possible. Remember, delirium is often multi-factorial. So even if there is a urinary tract infection that seems to have brought it on, the hospital team should try to spot any other factors that could be contributing (such as a medication side-effect, or a lack of glasses).
- Provide supportive care. It’s especially important to provide a calm restorative environment when a person is suffering from delirium. People may do better if they can avoid frequent room changes, and if they have a window allowing orientation to daylight.
- Prevent injury and manage difficult behaviors. This can be very challenging in those patients who become restless when delirious. Some hospitals have special “delirium rooms,” in which trained staff provide non-drug management of disoriented patients. As a last resort, the doctors do sometimes use low doses of medication. Research suggests that a small dose of antipsychotic, such as Haldol, is generally better than using a benzodiazepine (such as Ativan) which is more likely to make an older person’s confusion worse.
What you can do if an older person becomes delirious in the hospital
It can be scary to see an older person confused in the hospital, especially if you know that delirium can have serious consequences.
First and foremost, try not to panic. It’s time to hope for the best. Focus on doing what you can to help the delirium resolve.
As a family caregiver, you can play a very important role in providing a supportive and reassuring presence during an older person’s delirium. You can also:
- Advocate for minimum disruptions, and a quieter more pleasant room if possible.
- Make sure glasses and hearing aids are available, if needed.
- Help your loved one speak up if you think pain or constipation may be a problem.
- Question things if the hospital staff want to physically restrain the older person in bed. (This is a Choosing Wisely recommendation.) In many cases, if a person is dangerously restless, it’s better to start by trying a low dose of anti-psychotic, as mentioned above. Physically restraining a person often increases agitation and can lead to injury.
If you are of the really vigilant and proactive type, you may want to double-check that your loved one isn’t getting any sedatives or anticholinergic medications that make confusion worse. Even though these medications are risky for hospitalized older adults, it’s not uncommon for them to be prescribed!
What to expect after delirium: Even when all the right things are done — including getting the person home to a restful familiar environment — it often still takes a while for delirium to get better. In fact, it’s pretty common for it to take weeks — or even months — for delirium to completely resolve in an older adult. In some cases, the person never recovers back to their prior normal.
For more on delirium, see:
- 10 Things to Know About Delirium (includes information on delirium vs. dementia)
- Delirium: How Caregivers Can Protect People With Alzheimer’s (includes a list of helpful online resources that I’ve reviewed)
- A Common Problem That Speeds Alzheimer’s Decline, and How to Avoid It
You can also listen to our podcast episode, featuring leading delirium researcher Dr. Sharon Inouye, the founder of the Hospital Elder Life Program:
062 – Interview: Preventing Hospital Delirium & Maintaining Brain Health
This article was first published in 2014, and was last updated by Dr. K in March 2024.
Sharon Friend says
My 80 mother has been hospitalized twice in the past 2 weeks with pneumonia and a uti. She also has a diagnosis of dementia, but usually is just a little forgetful. She didn’t seem to know where she was at times. And pulled out her iv once. She called me the first night she was in hospital demanding that I come get her. By the time of her second discharge she was doing better. She was not sent home with oxygen because her level was staying at 92, in the first visit she was sent home with oxygen. I took her back to the assisted living/ full care facility that she’s been living at for over 2 years. She has been out of the hospital for 3 days now and does not think she is home. She gets angry at me when I tell her she’s at her home. She constantly brings it up when I visit. Not sure how I should deal with that?
Leslie Kernisan, MD MPH says
Sorry to hear that your mother’s been getting angry with you, that’s indeed very stressful.
What you’re describing sounds very typical for delirium making a person with dementia worse than usual. She will probably get slowly better with time, but it might take a while.
The difficult behaviors you describe (not realizing she’s home, getting angry at you) are actually not uncommon, they can be brought on by delirium but they also happen to many people with dementia, or they happen as dementia advances. So for help dealing with her behaviors and confusion, I would recommend reading more about how to cope with delusions and difficult behaviors. You basically need to remain positive, avoid arguing, redirect her, and so forth. There are some basic tips on the Family Caregiver Alliance website here: Caregiver’s Guide to Understanding Dementia Behaviors.
Good luck!
Erin says
Sorry to read your story.
When my Mum had delerium she was physically violent toward my Dad and I but not toward my brother.
Thankfully it ended when the infection went. Hopefully your Mum will feel better soon.
Erin says
My Mum has emphysema and had a long episode of delerium last year (about 2 months long). During, she told my Dad that she had another child out of wedlock before she married my Dad. Dad said she had stretch marks on her abdominal area when they were first married.
Is it common for people who are experiencing delerium to create ideas like this in their minds? It would have been the early 1950’s when many young unmarried women were forced to give their babies.
Having a secret half brother would certainly explain her beliefs and behaviours over the years.
Leslie Kernisan, MD MPH says
Interesting story!
Well, people who are delirious might say anything, but I think it’s in some ways similar to what people say or do in their dreams. A lot of it relates to fears, and then some of it might relate to something that’s on the person’s mind and now can bubble up. A well-functioning and normal brain actually expends a fair amount of energy deciding what’s appropriate to say and controlling that, and also can reason with fears to keep them from getting out of control. All of those functions decrease or disappear when people are delirious.
I think it’s hard to say whether your mother’s comments about another child were invented versus a truth that finally was able to come out. Either seems plausible…although honestly having a previous secret child sounds like an unusual invention. Good luck sorting it out and supporting your mother.
Erin says
Thank you Leslie,
I will discuss with my brother to see if we want to do a search.
Best wishes.
E
Micky C says
Very interesting article – My 94 yr old Mum went into hospital with heart failure she has had for a number of years – within 3 days she was confused and frightened and wouldnt eat or talk – she also seemed to lose all of her reasoning power – the doctors seemed to have written her off and even mentioned to me (in front of my mother!) that she ready to die !! – I said she needs to come home as she will improve – so against their judgement I organised a package of care 4 times a day – and withing 2 days she was eating , drinking and sat up in bed talking to me !! I did however mention Hospital Delerium and they looked at me as though I was mad – so I told them to Google it !
However now she is eating me out of house and home as she has a voracious appetite but unfortunately become doubly incontinent – I know she is unwell but ready for the scrap heap I dont think so – Thanks again for an amazing article
Leslie Kernisan, MD MPH says
Hm, what you describe does sound very classic for delirium and I can’t imagine the doctors would be surprised by this. Perhaps what surprised them is that you knew the name of this condition.
Or perhaps they didn’t realize that her state in the hospital was not her usual state. Unfortunately, it’s not uncommon for clinicians to assume that a 94 year old person might usually be confused. And how awful for them to tell you she’s ready to die, and in front of her! I’m so sorry you had this experience.
A good appetite is often reassuring, but a lot of incontinence can be a lot of work to deal with. If it’s new or worse than usual, I would mention it to her doctors, as it might be related to a medical issue that can be treated or improved.
I’m glad she’s better and thanks for sharing your story.
Billy says
All these stories give me so much hope.
My mother has just been moved to temporary respite care after 4 weeks in hospital with severe hyperactive delirium. Though in the last week she became stable but very drowsy. She also refused food on the last day.
In respite the food refusal and also liquid continued for the first 2 days. She also had some confusion and hallucinations.I waited 2 days for a doctor to come and see us after I raised my concerns on day 1.
My mum is 84 and was totally independent before her knee operation. I even had her walking at least an hour a day whilst in hospital. After 5 minutes with my mother, I was totally horrified when the doctor offered “sometimes elderly people have had enough of life and refuse to eat and we should let nature take it’s course”.
I made it clear to the doctor that I would continue to advocate for my mum and expect her to make a good recovery. Hopefully she will recover.
Thanks
Leslie Kernisan, MD MPH says
Sorry to hear about your mom. I’m glad this page has been helpful. Your mom is very lucky to have you advocating for her! If she was doing well before the operation, this gives her a better chance of eventually recovering. Good luck!
Lou lou says
Hi
My Mum was as diagnosed with delirium at the end of September. I won’t go into too much detail but we think it was related to a UTI (and possible diarrhoea, constipation and dehydration). My Dad and I tried to look after her at home but she ended up being admitted to psychiatric hospital at the beginning of November. Since being in there they had her on haloperidol (for 2 weeks), then quetiapine (another 2 weeks) then risperidone. On a night they’ve prescribed her zopiclone 7.5mg (after various other sleep related tablets) and mirtazepine. She takes 0.5mg risperidone on a morning and 1mg at teatime. Some nights she gets some sleep others she doesn’t. She is at her worst on a night and is confused. Although does come out of the confusion once she’s been awake awhile. She is agitated although does have settled periods. She is very drowsy during the day, even with sleep. She also has a morphine patch for pain. The ward have now said she has vascular dementia (along with the delirium) as they did ACE test and a CT scan (small infarcts from TIAs). I am really concerned about the medication she is on. Oh, they’ve also just started her on memantine (I know, VD, not Alzheimer’s) at teatime. My Mum came home on Monday on leave and will then be discharged. I want to look at reducing her medication. The ward seem reluctant. My first thought was the risperidone (due to
the dementia diagnosis and that she’ll be dropping off an hour or two after having it) from 1mg to 0.5mg at teatime. She’s fairly settled at this point and even when she’s had it at 7.30pm she’s been fine. She’s in bed by 9.30 anyway (will fall asleep no problem but wakes after a couple of hours). I wondered if anyone had any advice or thoughts? And on the fact that she’s been diagnosed with dementia (scoring 46 on ACE test) when she still has delirium. Prior to the delirium she was doing online banking, planning activities, looking after grandchildren, baking etc etc.
Thank you.
Leslie Kernisan, MD MPH says
Sorry to hear of your situation, sounds very tough and scary for your family, and probably for your mother as well.
She’s now been confused for several months, but if she really was doing banking and otherwise doing quite well prior to September, then I’d say there’s a chance that with enough time and rest, she might improve…probably not back to the level she was before, but perhaps better than she is now. People may need to be home in a familiar environment for months, in order for delirium to fully resolve. The challenge is helping her get enough rest and restoration without over-medicating her, and this can be especially hard if her confusion is causing a lot of difficult behaviors.
If she is often drowsy during the day, then it certainly might be possible to reduce her medications. You will need to work closely with her doctor to do this. Here are some articles on the site that might be helpful to you:
5 Types of Medication Used to Treat Difficult Dementia Behaviors
4 Medications to Treat Alzheimer’s & Other Dementias: How They Work & FAQs
How to Manage Sleep Problems in Dementia
Cerebral Small Vessel Disease: What to Know & What to Do (This might help you better understand her head CT findings.)
Also if she is coming home and is often confused, I highly recommend getting more education and support on managing difficult dementia behaviors. There is a good overview here: Caregiver’s Guide to Understanding Dementia Behaviors. You can also learn a lot from an online (or in-person) support group.
Your goal should be to minimize conflict with her and upsetting her, so that any remaining delirium can resolve over time. So for instance, make an effort to avoid arguing with her or trying to reason with her, and instead offer lots of love, support, and whatever generates more positive emotions and fewer upsetting ones.
All of this is hard to do, when one is tired and stressed out and misses the way our older relative used to be. So be sure to take care of yourself when you can, and keep reaching out for information and support. Good luck!
Quinn says
I’m writing this sitting in the hospital with my 79 year old mother. We brought her in two nights ago as she was having episodes of slurred speach which I feared were signs of a stroke. All tests have revealed no stroke occurred. She has had very limited mobility over the last 90+days due to 2 pinched nerves in her back. Diagnosis was extremely slow and finally surgery was scheduled for December 27th. In the 5 weeks since the surgery was scheduled she has been in intense pain and has been on numerous meds to ease her suffering. Tonight she called asking me to call the cops as she feared the nurses would kill her. I’m great full to have found this article and the comments. I’m planning on taking her home one way or the other today to familiar settings to help her reorient as I’m afraid in this current state surgery would be delayed. I do not believe she can tolerate much more if the nerve pain is not fixed. I did not properly understand how this long term pain she has been under was affecting her. Would this cause the doctors to postpone or cancel her surgery? She has never experienced any dementia before and has been in great health. As others have mentioned this dillirium has been very unsettling. Seeing a loved one change so dramatically is devastating.
Thank you for your help.
Leslie Kernisan, MD MPH says
Sorry to hear of your mother’s situation, it sounds very scary for her and for you.
If she has started worrying that the nurses are going to kill her, then it does sound like she may be developing some delirium.
Her pain sounds challenging. I can’t say whether the proposed surgery is likely to help; it really depends on her situation and what kind of surgery they have in mind. Obviously going through surgery is a strain on an older person’s body, so it would be best to proceed if the likely benefits outweigh the strain of surgery and the risk of complications.
I also can’t say whether they will want to cancel her surgery or not.
You may want to try to get a second opinion regarding the management of her pain, there may be some other possibilities to make it more bearable.
Otherwise, she might get better at home. Fundamentally, what she needs is for the underlying cause of her delirium to be treated and then for contributing factors to be minimized. If she goes home but remains in severe pain, this might keep her delirium from resolving as quickly as it otherwise would. Good luck and I hope she feels better soon.
Lori says
Hello and thank you so much for posting this article, it’s so important and not enough people are educated on this. Our Dad just turned 83 and he’s been through so many things, I can’t begin to list them here. But in September, 2017 they tried to save his leg by doing multiple procedures and they couldn’t do anything more for him and had to amputate it. This was due to Peripheral arterial disease. It was our worst nightmare for him and it has been very stressful and upsetting to him. As he has been in the hospital and rehab (he winds up back in the hospital for one reason or another every couple of weeks), he has developed this delirium and it seems to becoming more severe. A lot of the Rehab and Hospital staff seem uneducated about it, and this doesn’t help. He is completely normal when he is home and the delirium didn’t start until a few weeks in, but it just keeps spiraling. I do have some questions.
Is there any difference between this and what they call Sun Downing?
He has had mild experiences with this during past hospital stays but has bounced back quickly when he returns home. This time around, it has been such a long time that he hasn’t been home and it has become so severe. He is not only confused now, but he is hallucinating and becoming belligerent to everyone around him. This is totally out of character for him and it’s so upsetting. What are the chances of him bouncing back when we finally get him home?
What can we do at this point to try and reverse it?
It’s all very scary, frustrating, and sad and we don’t know what to do. The hospital just called my Sister as we speak because my Dad is screaming our names at the top of his lungs and it’s 10:45pm. They asked her if they can give him morphine to calm him down and make him sleep. The staff at the rehab and hospital don’t seem to know how to handle it either. 🙁
Any words of advice that you can give would be greatly appreciated.
Leslie Kernisan, MD MPH says
Sorry to hear that your father is in this difficult situation. Yes, what you’re describing does sound like delirium.
Sundowning is when a person with a dementia such as Alzheimer’s disease gets more agitated, or shows an increase in difficult behaviors, in the late afternoon or evening. It is probably somewhat related to getting tired. Sundowning has not been as clearly defined or studied as delirium.
In terms of helping your father: at this point he has been going between hospital and rehab for 2-3 months. So it is hard to know whether his current spells of shouting and agitation are due to delirium that hasn’t had a chance to resolve, versus a new cause or trigger (such as a new infection or complication). If a patient gets worse, it’s often reasonable to re-do an evaluation for common delirium causes: infection, dehydration, electrolyte disturbances, medication side-effects, and so forth. I also always recommend checking for constipation and pain.
A little morphine might be reasonable to try, if they have checked for other triggers and if they think the main cause is pain. Bear in mind that IV morphine only works for 1-2 hours and oral morphine works for about 4 hours. Morphine and other opiates are also constipating.
Home is often a more restorative environment where people can finally start to recover from delirium. You have probably already looked into this, but you might see if there is any way to bring him home with home health services. (This might require a lot of hands-on help from family initially, which can be tough to manage if everyone works.)
Good luck and I hope he starts to recover soon.
Victoria says
My 77 yro mom tas hospitalized last Sunday due to a UTI which caused an almost 104° fever. She was only blabbing and saying nonsense things. She was in the hospital for 5 days and 2 of them woke up sort of scared not recognizing where she was and thinking she was moved to another room. She actually doesn’t remember getting sick and being in an ambulance fue to the sky high fever. Doctors agree she was having delirium. She got some brain scans taken and the doctors said everything looked as it it supposed to look at her age. Seeing her like that frightened me quite a bit. She is back at her house now but I sense her somewhat slower than before this nightmare. I think I might be overwhelming her with questions and statements to make sure she’s OK because she gets very nervous when I start asking 🙁
Leslie Kernisan, MD MPH says
Yikes, that sounds like a scary experience for your mom and your family.
It sounds like she is better now, although perhaps not quite back to her usual self. She may well continue to improve with time; many older adults do.
I understand your concern for her; I would want to be asking a lot of questions too. That said, if it makes her nervous, consider dialing back your questions. The more restorative you can make her environment, the faster she can heal. So you want to minimize anxiety and stress, or at least only make her anxious if there’s a really good reason to do so. Good luck and I hope she continues to improve.
Teri Sweeney says
My 88 year old father was recently hospitalized following a fall at home. He has a history of CVA with expressive aphasia. He also has a dx. of mild dementia. Prior to going to the hospital he was independent with his ADL’s, continent, a community ambulatory (although walking on uneven surfaces was more of a challenge) and even did work around the house i.e. raking leaves, mowing lawn. Once admitted to the hospital he was put on medications that he was no longer taking even though my mother gave them a current list of his medications. Nobody bothered to clarify with his primary care physician.. He does take Kepra 750 for history of seizures but they ended up also putting him on Vimpat 200 as well as tegratol. Additionally they changed his HTN medication and added Amlidopine. He previously had a reaction to the Vimpat and Tegratol rendering him essentially unresponsive. Once they were eliminated, he gradually came back to his baseline. With this hospitalization he was on those seizure medications for a week. Then someone finally read through his chart and found out his previous reaction so it was then discharged. By that time he was barely aware, mixed up with sleeping ( up at night, almost unresponsive during the day), incontinent and barely able to walk. He was then transferred to sub-acute rehab. I kept saying that his current situation represented a rapid and drastic change, but nobody listened. I kept getting the response, “well the doctor really thinks it’s the dementia. Even advanced dementia residents are alert. Things were then pretty erratic. Some days, or portions of the day, he was better, then he would go back to eyes closed, barely participating in life. After I found out about the change in HTN medications, I requested that he go back to what he was on at home. That did appear to help somewhat. Also, previous to that I had them take him off his Namenda and Zoloft, thinking that they were causing him to be so drowsy and not consistently sleeping through the night. With each change in medication, I gave it about a week before asking for another change thinking that it might help pinpoint where the problem was. During this time I tried to get him out for at least a ride in the car. We then started to bring him home for several hours during the weekends. He would start out not so great, but by 5PM he was already perking up and moving better. We would then return him to the SNF as required by Medicare. The next day we were back to square one: not sleeping well, so fatigued during the day the he was barely able to participate in therapy, even though he was up all day minus an ~ hour nap. Because of his fluctuating participation he is not progressing well with therapy and will likely be cut by Medicare. I’m not sure if bringing home permanently would be better or not. Are the visits home more detrimental? My mother and/or I are with hime about 10-12 hours a day. If we bring him home and he doesn’t recover it’s going to be difficult to get him back into an SNF. It’s just me and my 84 year mother (who is in great shape for her age)
Leslie Kernisan, MD MPH says
Ugh, so sorry you have had to go through this.
I do find that many older adults seem to do better at home, compared to the SNF. Home is usually a more reassuring and restorative environment, and that helps delirium resolve. He should be eligible for home health services, which can provide nursing and PT and OT and other services. But of course, he will need a lot of help and assistance from you and your mom if he comes home now, which may or may not be feasible for you to provide.
In terms of whether he can be cut by Medicare for not improving: the 2013 “Jimmo Settlement” established that improvement is NOT necessary, and that Medicare beneficiaries are eligible for rehab if it helps them maintain their current abilities. (See here.)
Your dad did have a pretty good level of function before he was hospitalized, so he may have a good chance of recovery. But it may well take a long time. Another reader shared the story of her mom’s delirium recovery with me recently, see here.
Your dad is lucky to have you there doing all this work advocating on his behalf! I hope he gets better soon. Good luck deciding on your next steps.
Donna Foster says
Thank you for this information! I am 60 and in the past ten months I’ve had three surgeries for rectal cancer, which included first, a colostomy, then an ileostomy at the time of the resection. I certainly wish I had known about post-op delirium before now! I experienced paranoia, confusion, hallucinations and tearful meltdowns, all of which occurred either coming out of anesthesia or at night, and after reading your article I can see it was caused by multiple triggers. It’s interesting to me how real the hallucinations seem even after a year. It’s also disconcerting that as sweet as my nurses were, only one seemed to be tuned in to my distress. Being very observant and kind, she used my faith and the importance of family to “talk me in off the ledge” one night. It seems to me it wouldn’t take a great deal of training to bring nurses up to speed on how to recognize and handle patients with delirium.
What a relief it is to have learned, on this one year anniversary date of that first surgery, that I wasn’t responsible for my strange behavior! I continue to have some loss of memory, and very often vocabulary as well, but I’m exercising on a regular basis now, both physically and mentally, which I believe is making a significant difference. Today I think it becomes my mission to educate my family and friends on this subject! With such a large, elderly population of Baby Boomers, I’m surprised this isn’t a more common topic.
Leslie Kernisan, MD MPH says
Thanks for sharing your story. I’m glad you’ve found it so helpful to learn more about delirium. I agree, I wish more people understood this condition. Wonderful that you are helping others learn about it!
Barbara Citron says
I was in the hospital after a couple of days, and suddenly I realized I didn’t know where I was. So I called my daughter from my cell phone and scared her half to death by saying I had no idea where I was; she had to come pick me up immediately . I didn’t see any people, although I’m sure they were there. My daughter came and reassured me and I came out of it.
The second time was in a rehab about a week later, when I had a lengthier experience. I dreamed that all the nurses were keeping me in a wheelbarrow/wheelchair type of thing and that they were all going to kill me. I tried to make sense of it all, and wondered why ALL the nurses were in on the plan. I think I called a few people b…., which was not usually in my vocabulary. When my daughter came, I told her about it, and then asked if she could see all the gold and silver threads that were all over the air; and I pointed to the ceiling on which I thought there was a map of Summit, NJ. No nurses or anyone seemed to notice my discomfort. Even though I knew about hospital paranoia at the time, it still bothers me when I think about it.
Leslie Kernisan, MD MPH says
Yikes, that sounds pretty distressing. I’m sorry that the nurses and other staff didn’t seem to notice.
Having past delirium does put one at risk for future episodes, but older adults can reduce their risk by taking precautions — if possible — if they have to be hospitalized or get surgery.
Hope you have made a good recovery from this experience. Take care and good luck for the future.
Tmalpass says
It’s good to hear this first hand experience!