The dangers of hospital delirium in older people
Posted By Carolyn Schatz On November 16, 2011
No matter how sick my grandmother got or what her doctors said, she refused to go to the hospital because she thought it was a dangerous place. To some degree, she was right. Although hospitals can be places of healing, hospital stays can have serious downsides, too.
One that has been getting a lot of attention lately is the development of delirium in people who are hospitalized. Delirium is a sudden change in mental status characterized by confusion, disorientation, altered states of consciousness (from hyperalert to unrousable), an inability to focus, and sometimes hallucinations. It’s the most common complication of hospitalization among older people.
We wrote about treating and preventing hospital delirium earlier this year in the Harvard Women’s Health Watch. In the New York Times “The New Old Age” blog, author Susan Seliger vividly describes her 85-year-old mother’s rapid descent into hospital delirium, and tips for preventing it.
Although delirium often recedes, it may have long-lasting aftereffects. A recent study published online in General Hospital Psychiatry found that hospital delirium can contribute to premature death. Among people over age 65 admitted to a general hospital, those diagnosed with delirium were more likely to die within one year than those without delirium.
The findings echo those in an analysis published last year in The Journal of the American Medical Association (JAMA) that found a link between hospital delirium in elderly people and poorer outcomes, including death, dementia, and institutionalization (such as in a nursing facility) within one to four years.
Hospital delirium is especially common among older people who’ve had surgeries such as hip replacement or heart surgery, or those who are in intensive care. Anything that interferes with neurotransmitters—the brain chemicals that communicate between nerve cells—can trigger it, including inflammation, infection, and medications. Also implicated are a host of potentially disorienting changes common to hospital stays, including sleep interruptions, unfamiliar surroundings, disruption of usual routines, separation from family and pets, and being without eyeglasses or dentures.
As described in the Harvard Women’s Health Watch, family members and close friends can do a lot to help prevent or limit delirium in an older person:
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