Info on

Delirium

9 October 2024

Delirium is a condition of acute confusion accompanying a severe illness or an extreme medical condition, which characterizes older adults.

It is important to examine the symptoms and make a diagnosis as early as possible, and at the same time treat the symptoms of the acute confusion that may endanger those who suffer from it. Among the possible causes of delirium:

  • Infections such as urinary tract infection.
  • Constipation or urinary retention.
  • Abrupt discontinuation of medication.
  • Effect of anesthetics in surgery.
  • Influence of drugs or alcohol.

delirium is a serious diagnosis which increases the risk of experiencing it again. 

Delirium is characterized by waves, the patient can wake up and look perfectly fine, but at night the confusion may return. Therefore, if a patient underwent an inpatient surgical procedure, was discharged home and after a few days feel confused, it is important to check the symptoms and diagnose as early as possible, partly because sometimes delirium exposes hidden dementia, or worsens it.

The treatment of delirium includes:

  • Making a calm and supportive environment.
  • It is important that there is always someone by the patient's side and they can reassure and treat if necessary.
  • Drug treatment, which is adjusted according to the degree of cooperation of the patient. It is important to know that the drugs for confusion are antipsychotic drugs and have many side effects. Therefore, it is important to use them in doses as low as possible and only according to the exact instructions of the treating physician.

Delirium is a condition of acute confusion accompanying a severe illness or an extreme medical condition, typical among older adults. Delirium is a medical condition that is difficult to diagnose and requires immediate medical attention. Occasionally, delirium exposes a hidden dementia or worsens it, and it is important to know that delirium is a serious condition. If delirium is diagnosed, the risk of recurrence will be significant.

Underlying causes of delirium

Delirium has a physical-medical cause that should be discovered as early as possible, as a means to treat and relieve the symptoms of acute confusion. Among the possible underlying causes of delirium:

  • Disturbances in the absorption of salts in the body because of dehydration or other reasons.
  • Infections such as urinary tract infection.
  • Constipation or urinary retention.
  • Sudden discontinuation of medications that are supposed to be gradually reduced.
  • Effect of anaesthetics after surgery.
  • Metabolic disorders such as excess or lack of calcium in the body.
  • High-intensity or long-term pains, for example after surgery, or because of an infection.
  • A change of familiar surroundings of patients with dementia.

How to diagnose delirium

To relieve the symptoms of delirium it is important to make an early diagnosis, including a differential diagnosis, to confirm delirium and not Sundowning, which occurs among patients with dementia at sunset, or with rare neurological diagnoses.

Diagnosis is performed with CAM method (Confusion Assessment Method), which is a diagnostic method performed at the patient’s sickbed, in which the following issues are examined:

  • Fluctuating course (instability): a rapid onset of symptoms which develop within hours or days. It is characterized by waves of confusion that come and go several times during the day; patients seem totally clear-minded and eloquent some hours of the day and night, however, on some of the time they seem completely confused.
  • Impaired level of attention: it is possible to confirm a significant attention disorder when asking a person to complete a task that requires a consistent thinking process, for example, naming the days of the week in reverse order.
  • Disorganized thinking: inconsistent contents in a conversation, disruptions in the flow of thoughts and abrupt shiftsfrom topic to topic.
  • Altered states of consciousness: the patient is not in a normal state of alertness but rather in a state of agitation, or lethargy (an abnormal medical condition, in which the person seems indifferent to the environment and is essentially in a state of drowsiness), or sluggish (a wide range of abnormal states of consciousness).

It is important to note: to diagnose delirium, clauses 1+ 2 coincide with clauses 3 or clause 4, or both.

When a person is hospitalized in intensive care there are some additional diagnostic tools, such as CAM-ICU.

Tests after diagnosing delirium

Once delirium is diagnosed, there are several medical tests that should be done to identify the medical condition that has caused it.

  • Temperature, pulse, blood pressure, blood oxygen saturation, pain, constipation, and urinary retention.
  • If necessary, blood tests are also performed to diagnose an acute condition.
  • In certain cases, imaging will be required, according to the patient’s condition and according to the procedure he or she has previously undergone, for example, CT, in the event of a cerebrovascular accident (stroke), or ultrasound, with suspected gallbladder inflammation or urinary retention.

Treating delirium

Treating patients suffering from delirium is performed with reference to their overall physical condition, namely, when a physician tries to identify the underlying organic illness that has caused delirium, he or she must, at the same time, provide solutions to address the confusion that the patient experiences.

  • Calm and supportive environment: family members and relatives taking care of the patient should offer a calm and supportive environment, including eating and drinking, if the situation allows it.
  • Not to be left alone: it is important that the patient is not left alone, and that a family member willl stay by the patient's side and be able to reassure and treat if necessary.
  • A post-operative patient which is released and feels confusion: delirium has wave-like symptoms; accordingly, a patient may wake up in the morning and seem fine, however, at night confusion may reappear. Therefore, a patient who has undergone a surgical procedure and is released home after several days, may still feel confused. It is essential to maintain community-based medical supervision as well, and if necessary, refer to a geriatrician.

Fast identification of a symptom or symptoms initially causing delirium may not necessarily help treat them quickly. The symptoms of confusion can last up to several weeks, while improving day by day.

Drug treatment of delirium

Occasionally, acute confusion is accompanied by self-harming behavior, for example, agitation, expressed by attempts to climb out of bed after surgery, etc.
If it is difficult to control these situations in the presence of close relatives (or caregivers), therefore, the use of drug treatment may not be avoided

Medications to relieve confusion are anti-psychotic drugs and have numerous side effects, therefore, it is essential to use the minimum dose possible and according to the specific instructions of the family physician only.

  • If the patient is cooperative, he or she can be treated through pills or drops taken orally.
  • If the patient is uncooperative, and the self-harming behavior worsens, injectable drugs should be used.

Can delirium be prevented

The best way to cope with delirium is to prevent it. If possible. As we grow older and beyond, each deviation from balance is powerful and difficult to restore. There are several measures we can take to prevent delirium:

  • Being ready: it is important that family members are ready for the likelihood of confusion, make a distinction between confusion and the person they know, and refer the patient to an examination to identify the organic cause for the delirium as close as possible to the onset of confusion.
  • Water: it is important to drink enough water, and discuss it with the family physician.
  • Pain treatment with appropriate medications.
  • Digestion: preventing constipation or urinary retention.
  • maintain mobility: for those patients who are hospitalized in a nursing care, it is very important to maintain mobility: a patient’s movement and maintaining an accommodated movement prevent complications, such as delirium. If there is no medical restriction, and there is a caregiver or a relative with the patient, it is recommended to move him and encourage him to be in motion.