Older adults and sudden confusion: What do we need to know about delirium?

Every month of March, World Delirium Awareness Day is celebrated, an opportunity to shed light on a syndrome that is still very invisible but affects thousands of people every year, especially elderly and hospitalized people. Delirium, also known as acute confusional syndrome, is a disorder that appears suddenly and alters consciousness, the ability to think clearly, or the perception of what is happening around.

Although it is a frequent problem, especially in elderly people (in situations of acute illness), in post-operative periods or ICU admissions, it often goes unnoticed. The fact that it is so invisible is a risk, because an early diagnosis can prevent complications, reduce hospital stay and significantly improve the well-being of the affected people and their families.

What exactly is delirium?

It is an acute and potentially reversible neuropsychiatric disorder that can appear within hours or days. It appears due to different factors and the people who suffer from it may present the following symptoms:

• Difficulty concentrating
• Disorientation
• Drowsiness or, on the other hand, agitation
• Sleep disturbances
• Hallucinations or delusional ideas

All these manifestations can fluctuate throughout the day and tend to worsen at night.

“The most important thing is to understand that delirium is not part of the natural ageing process,” explains Eva M. Melendo, deputy to the Nursing Director of Intermediate Care at Parc Sanitari SJD. “There is always a cause behind it, and detecting it is key to reversing the problem,” she adds.

Specialists distinguish three forms of delirium: hyperactive (with agitation and hallucinations), hypoactive (with apathy and drowsiness) and mixed (with alternating episodes). The hypoactive type is the most difficult to detect because the person may simply seem more tired, sleepy or “switched off”, when in reality they are suffering from a disorder that requires immediate attention.

How can we prevent it or reverse it?

Delirium can appear for multiple reasons: an infection, dehydration, a metabolic imbalance, poorly controlled pain, medication (such as benzodiazepines or opioids), or environmental factors such as the change of environment during a hospitalization.

The main treatment consists of identifying and solving the triggering cause, for example, a urinary infection or a metabolic problem. The sooner it is detected, the better the results.

In addition, a key element is what healthcare professionals call ‘environmental containment’, which translates into a set of simple but very effective measures:

• Provide a visible clock and calendar
• Allow the use of glasses or hearing aids
• Ensure good lighting and clearly differentiate day from night
• Maintain routines and a calm environment

These actions help the patient to orient themselves and reduce the risk of the onset or worsening of delirium, and avoid the use of physical or pharmacological restraints.

Suspicions? Act!

If you are caring for an elderly person who suddenly presents confusion, behaviour changes or disorientation, consult a healthcare professional quickly and do not attribute it directly to age.