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In This Episode:
Dr. K talks with geriatrician Sharon Inouye, MD MPH, a nationally-known expert on delirium who is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center at the Institute for Aging Research, Hebrew SeniorLife. They discuss:
- What is delirium and what are common symptoms of delirium
- What are common causes of delirium, and what can make it worse
- How Dr. Inouye became interested in studying delirium
- The difference between delirium and dementia, and how the two conditions are related
- The problem with using restraints and bed alarms, when someone is delirious
- How to treat delirium, and how to keep a person safe while delirious
- How the Hospital Elder Life Program helps reduce delirium (by 40-60% in some studies!)
- Why many hospitals still don’t have a HELP program
- The most effective ways to maintain brain health while aging
Related episodes:
039 – Interview: Creating Age-Friendly Health Systems
014 – Delirium & Hospital Confusion
Related Resources:
- Hospital Elder Life Program (HELP) for Prevention of Delirium
- 10 Things to Know About Delirium
- Hospital Delirium: What to know & do
- 7 Common Brain-Toxic Drugs Older Adults Should Use With Caution (about anticholinergics)
- Choosing Wisely: 5 More Treatments to Question in Older Adults
- National Academy of Medicine Report on Cognitive Aging
- 4 Types of Medication to Avoid if You’re Worried About Memory
- National Institute on Aging: Brain Health Resources
- The 2015 American Geriatrics Society Updated Beers Criteria: Medications that Older Adults Should Avoid or Use with Caution
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Laurie R says
My husband of 41 years used to be sensitive and loving. He’s always made up words and convinced they were legitimate and someone called it neologism?
His whole family going way back suffered heart/cardiovascular deaths and is high risk.
He had a neuro-psych-assessment that revealed a couple strokes and diagnosed with mild cognitive impairment. Since then he’s had several hospital surgeries in a short time and then suffered a massive heart attack in the middle of COVID-19 onset. He was a CABG patient who had a quadruple bypass.
Each time I noticed big confusion in him and at times scared then angry at me. Apparently post operative delirium that seemed worse after each surgery. They didn’t see it because they don’t know him like I do. Sensitive and crying, then rude and angry with glares that seem to throw daggers at me directly. He’s definitely extremely quick to anger with me and sometimes with no reason at all. He has no empathy towards me, and screams horrible things to me at the top if his voice telling me its all my fault. If I tell him to speak nice and soft, he gets worse. Sometimes he will raise his hand back as if he wants so badly to strike me but doesn’t but the look in his eyes looks black with anger. I cry all the time over this and have tried at the best of times to talk to him but its no use. He’s hurting my feelings terribly.
What is this a sign of?
Nicole Didyk, MD says
It sounds like you’re seeing a dramatic change in behaviour in your husband and it must be so distressing for you.
After a stroke, a person is at higher risk for depression, which can cause irritability and angry outbursts. Those with dementia are at risk for depression as well. Depression symptoms can improve with medication in many cases, and a family doctor or Geriatrician could help sort that out.
Talking to the person with the behaviour change might not be productive, especially if they have a medical condition that makes it harder for them to modify their responses. It can even lead to more upset and friction.
The other part of living with behaviour changes is making sure that the partner has support and the opportunity to take breaks (also called “respite”). A counsellor or social worker would be a good professional to help in such a situation.
Audra Lindfors says
My mom was recently admitted to the hospital for a sudden onset of confusion and delirium. The diagnosis was alcohol withdrawl and once the severity of treatments were done she became even more delirious she was fine at home and then within a few hours she couldn’t walk on her own and she has incontinence, the hospital also just found a urinary tract infection after about 10 days of being there. Its just very scary and I understand that her type of delirium is a bit different and much more severe. What are some things I can do to help her and to speed up her recovery.
Nicole Didyk, MD says
I’m so sorry to hear about your mom’s experience with delirium. You’re right, the delirium of alcohol withdrawal can be very complex and dangerous period the treatment for alcohol withdrawal delirium usually involves giving benzodiazepine’s which are sedative hypnotic medications. Although these medications can prevent some of the risks of alcohol withdrawal, they can also cause sedation.
You also note that your mom’s alertness and function tended to fluctuate. This is very typical of delirium, as I mentioned in my YouTube video here.
In general it’s always easier to prevent a delirium than to cure one but most of the measures that we take to prevent delirium seem reasonable to try in order to try to speed up the recovery. This includes things like getting a person back into a familiar environment and routine as quickly as possible, encouraging the person to do physical activity , avoiding dehydration, taking medications that are prescribed and trying to avoid any medications that could further cloud thinking or alertness.
Rochelle says
My elderly parents currently dealing with hospital delirium. Not related to COVID. No visitors rules boost situation to more critical status when they cannot connect with family. Getting a doctor to treat the whole patient and finding resources for a care plan for an elderly parents is challenging.
Nicole Didyk, MD says
Are both of your parents in hospital? That would be a challenge. You’re right that hospital care is often disease-focused and not very holistic. A consultation from a Geriatrician would probably be helpful, but given the pandemic, it might be hard to access that resource too.
This article from Dr. Kernisan might have some helpful tips. It’s about creating a Senior-Friendly Hospital system, a very hot topic right now.
Debra Carr says
MY MOM HAS BEEN IN HOSPITAL 5 TIMES IN 6 WEEKS HAS DELIRIUM NOW SO HARD TO DESL WITH THIS INFORMATION HAS HELPED
Leslie Kernisan, MD MPH says
Thank you for the feedback, I’m so glad the information has been helpful!
jen says
Fabulous resource – working through a situation with a parent currently and this was tremendously helpful and easy to listen to and digest.
Thank you!!
Leslie Kernisan, MD MPH says
So glad you found it helpful, thank you for letting us know! Good luck to you, hope your parent improves soon.