Patient care

Delirium can be a deadly threat to nursing home residents

JAOA literature review offers clinical guidance for physicians and long-term care staff.

Delirium—a syndrome of altered mental status characterized by disorganized thinking, deficits in attention and a fluctuating course—is often undiagnosed in long-term care patients, according to a recent review published in The Journal of the American Osteopathic Association.

The comprehensive review found delirium affects nearly 18% of long-term care residents, with a staggering 40% one-year mortality rate. The similarity of delirium symptoms to those of dementia can cause delirium to often go undiagnosed or misdiagnosed in elderly patients with dementia.

“It is unclear whether delirium itself causes deterioration in brain functionality that ultimately can result in premature death, or if delirium is a symptom indicating a mind and body already in decline,” says author Martin M. Forsberg, MD, an assistant professor in the Department of Geriatrics and Gerontology at the Rowan University School of Osteopathic Medicine in Stratford, New Jersey.

The most acute symptoms typically last one week; however, it can take weeks or months for patients to get back to baseline. Persistant delirium can accelerate dementia, making it difficult to accurately determine whether the patient still has delirium or a worsened baseline of dementia.

Tips for physicians

Dr. Forsberg, who conducted the review, shares what physicians can do to help their patients in long-term care.

  • Prevention is key. “Avoiding non-essential surgery and hospitalizations may decrease the incidence of delirium,” Dr. Forsberg says. “Maintaining hydration and minimizing medication exposure may also be an effective means to prevent delirium.”
  • Evaluate your patient’s surroundings. Some studies noted links to environment: when there was no clock in a patient’s room, patients were twice as likely to have disruptive behavior. Patients without a phone in their room were three times as likely to have disruptive behavior.
  • Work with the patient’s family members, who often are in the best position to recognize the subtle changes that present with delirium. “When I hear a geriatric patient’s family say, ‘Mom is more confused than usual,’ I tend to act,” says Dr. Forsberg. “Dementia doesn’t change suddenly and cause a worsened condition in a week, but delirium absolutely can.”

See the JAOA review to learn more about delirium.

1 comment

  1. I was called by a patient’s family about a patient in a psychiatric hospital. The hospital doctor was out of town and left no one on call. The nurses were to wing it.
    The family described symptoms of confusion, agitation, and restlessness.
    I had them check him out AMA and take him to the ER and had the ER give him IV fluids.
    The ER doc agreed with my over the phone diagnosis of dehydration. After only 1 liter of fluid the man became lucid and coherent again. He was given some more fluids and kept for observation for a day or two. It was not his psych meds or organic disease.

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