This common and frightening syndrome resembles dementia but comes on much faster

“During the day he is completely calm, but at night he gets very agitated.”

“Tonight she didn’t stop calling for her mother, who died years ago. But she slept all day and it was almost impossible to wake her up.”

These testimonies will be familiar to many relatives and caregivers of an elderly person who has to spend time in hospital. They testify to a situation that is all too common: an elderly person is admitted to hospital and experiences a sudden deterioration in their health, mainly characterized by spatial and temporal disorientation and agitation.

It looks like dementia, but could it be something else?

Dementia or delirium?

Dementia is not a single disease, but a general term used to describe the progressive loss of cognitive functions: attention, concentration, orientation, problem-solving, etc. Ultimately, it hinders an individual’s autonomy and ability to perform daily activities.

Although many of these symptoms are similar to those of an unexpectedly agitated older patient, dementia develops gradually and over a long period of time.

In the case of the above testimonies, the patients can acute confusion, also known as delirium. This complex and common complication of hospitalization can have a direct impact on the morbidity and mortality of patients. It is therefore of great importance to prevent it, or, failing that, to make an early diagnosis in order to treat it correctly.

According to several studies, it can affect 20% Unpleasant 30% of elderly hospitalized patients.

A patient suffering from delirium may experience the following symptoms:

• Changes in attention levels and alertness, which can vary throughout the day. Often, an affected person is hyperalert at night, but very sleepy during the day.
• Changes in cognitive function, including memory loss (not being able to remember what happened during the night), disorientation (thinking one is at home), speech disturbance or incoherence, and so on.
• Other symptoms may include changes in perception or hallucinations, agitation, or sudden, unpredictable mood changes.

Several factors play a role

There are many factors that come together in an older patient and give rise to these symptoms. Some of them are inherent to the aging process, such as polypharmacy (the simultaneous use of several medications) or sensory disturbances.

Many others are related to the process of hospitalization itself, such as stress caused by acute illness, the administration of certain medications, or surgery. Environmental factors also play a role, such as constant interruptions from nursing staff and other patients, making it difficult to get a good night’s sleep.

Despite sharing some features, dementia and delirium are clinically quite different. However, they can and often do co-exist. In fact, a patient diagnosed with dementia is more likely to present with delirium during a period of hospitalizationThis may be due to a decrease in cognitive reserve, meaning that a person has fewer brain resources available to deal with stressful situations.

Can it be treated?

The good news is that delirium can indeed be treated: the sooner the better. We must keep in mind that one of the biggest risks is that it goes unnoticed and no action is taken. This is even worse in patients with dementia, since dementia is associated with changes in alertness levels.

If delirium is a reaction to a particular medication, the solution is simply to stop it. If the cause is an infection, treating the infection may relieve symptoms. In other cases, specific pharmacological treatment will help control behavioral disturbances. Of course, all of these options should only be considered after a thorough assessment by a specialist.

There are also measures to prevent delirium from developing in the first place. Initiatives such as HELP (Hospital Elderly Living Program) In the US, these measures include nonpharmacologic measures such as reorientation, sleep management, early mobilization, use of sensory aids (such as glasses or hearing aids), hydration, and digestive health.

The implementation of such programs and the continued training of health care professionals are essential to prevent and promptly diagnose a problem that is rapidly developing into a silent epidemic.

How caregivers can treat or prevent delirium

There are several essential steps to help an older hospitalized patient prevent or manage the onset of delirium:

• Keep a regular day and night schedule. Open the curtains to let in sunlight during the day and help them sleep at night by reducing noise and turning off lights.
• Make sure the room is quiet so that the patient can feel as comfortable as possible.
• Keep the conversation simple, use short, simple sentences, and give the patient plenty of time to respond.
• If the patient becomes confused or afraid, remind him or her where he or she is and what is happening.
• If the patient becomes agitated or irritated by something in particular, remain calm and avoid arguing. A change of subject or environment can help a lot.
• If the patient is hallucinating, do not ignore or challenge him/her. You should acknowledge his/her feelings and try to calm him/her down gently.

In conclusion, prevention and early detection are essential for optimal treatment of delirium, a disorder that can have a major impact on a person’s physical and mental health, as well as serious consequences for public health.

This article has been republished from The conversation under a Creative Commons license. Read the original article.