People often confuse delirium and dementia, because both conditions cause confusion and appear superficially similar. Furthermore, people with dementia are actually quite prone to develop delirium. So a younger person generally has to be very very sick to become delirious. 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. 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.
What is Delirium — Symptoms and Causes
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. Delirium is less common in the outpatient setting e. 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 prepared to spot delirium if your parent or loved one is hospitalized, or has a dementia diagnosis. Although people often think of delirium as a state of agitation or restlessness, many older delirious people get quieter instead. This is called hypoactive delirium. Tell the hospital staff if you think your parent may be having hypoactive delirium. 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. Delirium can be the only outward sign of a potentially life threatening problem. For instance, older adults have been known to become delirious in response to urinary tract infections, pneumonias, and heart attacks.
In general, it tends to be older seniors with dementia who are most likely to show delirium as the only outward symptom of a very serious medical illness. Again, if you notice new or worse-than-usual mental functioning, you must bring it up and get your parent medically evaluated without delay. Substance abuse or withdrawl can also provoke delirium. To prevent delirium, learn about common contributors and try to avoid them or manage them proactively. A good delirium evaluation will attempt to identify and correct as many factors as possible.
To diagnose delirium, a doctor first has to notice — or be alerted to — the fact that a senior 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. However, if a senior is diagnosed with delirium, doctors generally should order tests and review medications, in order to identify factors that have caused or worsened the delirium.
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. Delirium is treated by identifying and reversing triggers, and providing supportive care. Delirium treatment requires a care team to take a three-pronged approach. First, they must identify and reverse the illness or problems provoking the delirium.
Second, they have to manage any agitation or restless behavior, which can be tricky since a fair number of sedating medications can worsen delirium. Furthermore, the once-popular practice of physically restraining agitated seniors has been shown to sometimes worsen delirium, and should be avoided if possible. 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 is an issue. Bear in mind that physical restraints should be avoided, as there are generally safer ways to manage agitation in delirium. Most people are noticeably better within a few days once the delirium triggers have been addressed.
But it can take weeks, or evenmonths, for some seniors to fully recover. You can facilitate recovery by creating a restful recuperation environment that minimizes mental stress and promotes physical well-being. Delirium has been associated with accelerated cognitive decline and with developing dementia.
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A study found that in such seniors, delirium during hospitalization is linked to a much faster cognitive decline in the following year. A study reached similar conclusions, estimating that cognition declined about twice as quickly after delirium in the hospital. For this, I suggest avoiding risky medications, getting enough exercise and sleep, being socially and intellectually active, and avoiding future delirium if possible. 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.
The HELP website has a section for family caregivers, which includes tips on how to prevent delirium. 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.
To prevent hospital delirium, carefully weigh the risks and benefits before proceeding with elective surgery. By educating yourself and helping your parents be proactive about prevention, you can reduce the chance of harm from this condition. 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. What questions do you have for Dr. Leslie Kernisan about delirium in the elderly? Share them with us in the comments below. I was diagnosed as Chronic obstructive pulmonary disease COPD carrier after tests were done to investigate my immune system. I started treatment with Bronchodilator which Helps open the airways of the lungs to make breathing easier and Steroid which Modifies or simulates hormone effects, often to reduce inflammation or for tissue growth and repair.
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My mother acts the same way. Never a nice word. Doesnt want anything to do with family. Now she got a UTI and for the past two days has signs of delirium. See things, people in her room, singing and children running everywhere. She seems to feel better when I sat in the room with her. I hope this only last a couple of days. Shes been up for 24 hours.
Pray for us all. My mom is 87 and was recently admitted into the hospital after a fall. They determined she has pneumonia and a urinary tract infection. She is on IV antibiotics to treat these infections and now had developed Delirium. However, she has no history of either and how can these dreaded diseases arise overnight? It is not that and sounds like hospital Deliria due to the infections and stress of being in unfamiliar surroundings and being confused at an advanced age. My year old dad was admitted into the hospital almost three weeks ago.
We took him because he was vomitting, had diarhhea, and his cognitive abilities were delayed. He has all kinds of issues and takes different medications for diabetes, high BP, COPD, arthritis to name the main ones. Then while there contracted pneumonia. He is now in a nursing rehab facility 6 days now and has issues walking. But what bothers the family the most is the lingering cognitive disabilities.
We are meeting with the doctor on Thurs to discuss what we need to do but I am definitely going to mention this. Thank you for sharing that with us, Linda. In the meantime, our partner website Alzheimers. While this is an excellent article it does not acknowledge that there are some dementia based illness in which hallucinations are a core component.
The CAM indicators upon which much stock is placed can be also pesent in someone with LBD as a core symptom is fluctuation as well as confussion. Your article does not relate that delerium may be present as a result of infection a UTI, or as a result of the use of anasthesia. I am not a medical practictioner but a have over 8 years experience in dealing with LBD and dementia and visual or audible disturbances — hallucinations should not be discussed without reference to LBD. WHO notes that LBD is the second most common cause of dementia — it is not rare but most frequesntly misdiagnosed.
My own first experience with delirium was with my own father, who became confused but refused evaluation when my mother tried to bring him to a doctor. I hope that your father manages to recover from his injuries, and that your family finds its way towards a more stable caregiving situation. It was so bad they were giving him Haldol at the hospital, which seemed to be only making it worse, or at least they kept giving it to him and he kept getting worse the more they gave him. Wish I knew what the doctor actually prescribed but whatever it was, or whether it was just the fact that it was something, it worked.
Thank you for writing about this! This distinction is critical for anyone caring for elderly to understand. There is one very important aspect related to delirium that would be very helpful to address — what to do when someone experiencing delirium refuses all medical testing. My family just experienced this with my 89 yr old father and despite all our efforts it resulted in disaster. His personality dramatically changed and his behavior rapidly became more irrational over a period of about 2 weeks.
Nobody could convince him. You want to take a more lighthearted approach to living. You want to see the brighter side of life without all the stress, worry, and anxiety that typically eats away at other people.
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But how do we do this? Well, it all starts with making a mental shift. This is all about making a shift in the way you think about your life and circumstances. The first thing to remember is that your perception of reality becomes your reality. In other words, your reality is colored by your expectations , and your expectations are a direct result of your beliefs. And, of course, your beliefs naturally sprout from the thoughts you consistently allow yourself to dwell upon.
How you interpret the events of your life determines how you see them, how you feel about them, and how you subsequently deal with them. Therefore, in a sense, everything is relative. You experience your reality based on how you have chosen to interpret that reality. Make a shift in how you think, and you subsequently alter how you interpret your world and what you experience as a result. This is a first important step that helps bring everything together full circle.
The goal here is, of course, to stop taking life so seriously, or in other words, to experience the fullness of life without the stress, anxiety, worry that most people succumb to. To make this perspective shift, you must first take control of your emotional responses. In particular, anger, worry, frustration, bitterness, etc.
For instance, have you ever considered that your worries are never a productive use of your time? Have you ever thought about how your worries are never actually going to improve the situation? Or, what about anger? Have you ever realized that anger rarely if ever resolves friction? And it never actually makes us feel any better about ourselves or the other person, right? Does venting frustration actually make things any better? Also, does neglecting responsibility and throwing blame upon other people fix the situation? Typically, the answer is no.
However, what it does show is that you have no control over your own life.
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Moreover, it shows a lack of emotional maturity. As we go about our day, we often allow our emotions to get the better of us. We allow trivial matters and small irritants to disturb our equilibrium. And you can then, of course, respond appropriately. Settle yourself at that moment and ask the following set of questions:. If life is stressing you out and your emotions are getting out of control, then just maybe you need to step back a little.
Step back from the situation and ask yourself whether or not at this moment you are taking things a little too seriously. Another important mental shift to make has to do with time. In particular, the realization that time is a precious resource that we cannot get back. How you spend the moments of your day is reflected in how you use your time. Or you can instead choose to spend it in a more efficient way focusing on making the most of every situation. Whenever you feel yourself getting overwhelmed by the circumstances of your life, take a moment to ask yourself the following questions:.
Remember, that it all comes down to the interpretations you make. Choose instead to interpret them differently in a more carefree and lighthearted way, and you will quickly shift how you think and subsequently how you respond to the situation at hand. To stress less and live life in a more lighthearted and carefree way, we must be willing and able to accept a new reality.
A reality where our perspective of our world and the circumstances of our lives are different than what most other people experience. To make this perspective shift, you must commit yourself to adopting a new view of your world. A view that will encourage you to enjoy the moment and take life a little less seriously. Have you ever contemplated the fact that this moment is only a tiny fragment of your entire life and existence? People take things too seriously because they tend to get lost in the moment. To them, only this moment matters.
And therefore, no matter what happens at the moment, they tend to give that moment a high degree of significance. Yes, this might be a significant problem within the context of this week, this month, or this year. However, your problem is all but part of a billion problems that people are dealing with across the globe. In fact, your problem might pale in comparison to what other people are dealing with right now. And across generations of time and space, your problem becomes even more meaningless and irrelevant. But possibly things are not as serious as you imagine them to be.
With this in mind, take a step back and view your problem from a global perspective. See it within the context of all the other problems people are currently dealing with. Just maybe then, this will help put the problem into proper perspective. No matter what you do, what you say, or the brilliant ideas you come up with. The reality is that people will not always support you, agree with you, or for that matter like you. To live life in a more lighthearted way, you must curb your expectations. And even if they do, it will probably be short-lived. Everyone, after all, changes their mind from time-to-time.
Accept and respect how other people are and the differences they bring to the table, and you will stop taking life so seriously. You will stop because you will come to the realization that the only opinion that truly matters is your own. We often take things too seriously in an effort to achieve a certain outcome. We have all these goals and aspirations, and a clear picture of what that will look like at some point in the future.
Yes, having goals is important. But just maybe we give our goals too much significance. We so desperately want to achieve that goal, that we quickly forget that the destination pales in comparison to the person we become along our journey toward that destination. Have you ever felt kind of empty inside after achieving a goal? That typically happens when we desperately strive for a single outcome. We eventually achieve our goal, but instead of enjoying it, we begin the pursuit of something else.
The joy is found within the journey toward your destination. What matters is the experience you gain along the way and the person you become as a result of that journey. That is something you can take away for the rest of your life. Yes, your goals are important, but the journey toward those goals is what counts. Therefore, whether you achieve the goal or not, matters little. With this in mind, find joy in the moments of achievement along your journey toward your goal. That is when the greatest happiness and fulfillment can be found.
Life is incredibly unpredictable and uncertain. We just never know exactly what will happen next. We can, of course, do our best to make predictions to control our outcomes, but the reality is that nothing is ever certain. This, of course, leaves us with only two choices. We can either try controlling everything, or we can embrace uncertainty. Trying to control everything will, of course, lead to massive disappointment. On the other hand, by embracing uncertainty, we can go with the flow of life. We can approach every circumstance with curiosity and fascination. And instead of stressing out about what will happen next, we can get excited about the possibilities and opportunities that await us around the corner.
The people who take life too seriously are often trying to control everything within their sphere of influence. And as we all know from experience, that rarely if ever works. Choose instead to accept that the world is unpredictable and that bad things will sometimes happen to the best of people. Then commit yourself to embracing every moment, and making the best of every situation.
When bad things happen, you have two choices. You can either give in to your anger, disappointment or frustrations — as most people do. Or you can simply choose to deal with the situation with a little sense-of-humor. If you choose to allow your emotions to get the better of you, you shut down all opportunity for making the most of your predicament. On the other hand, what if you chose to view the situation humorously?
What if instead of cursing or allowing your critical voice to get the better of you, you chose instead to ask:. Yes, asking these questions might not immediately help you find a solution. However, what these questions will do is put you in a more positive state-of-mind. A state-of-mind where you are more open and receptive to possibilities that may exist. Have you ever caught yourself making excuses?
Here’s Why You Need to Stop Taking Life So Seriously!
But are excuses really ever helpful? Instead of making excuses, choose to ask questions that help you find solutions to your predicament.
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When you ask questions that lead to answers, you naturally become more playful and open to the possibilities. You stop taking things so seriously and instead turn excuses into curiosity. And only via curiosity will you find the answers you are searching for. No matter how bad things get, keep in mind that things could be much worse.
When confronted with a problem, make a perspective shift. The key here is to stay open to the possibilities and to put your problem into proper perspective. Given this, treat it as a minor inconvenience. You are after all in control of how you interpret your circumstances. You, of course, already have an understanding of the mindset required to live life in a more lighthearted way. All you need now is some specific actions that can help you to put that mindset into practice. Some of these action steps will be quite straightforward. However, other action steps will require that you use your imagination and actually make a considerable effort to approach life and circumstances in a very specific way.
Therefore, your objective is to have fun. Enjoy the process and turn your life into an incredible adventure. Just imagine for a moment your entire life, and all the experiences you accumulate are nothing more but a game. This is, of course, your game. You, therefore, piece together the rules about how this game should be played.
Moreover, you decide how to score points and win the game of life. Remember also to celebrate your victories and enjoy the process.