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Hospital delirium is common and often goes unrecognized, reports Harvard Women’s Health Watch

Delirium — sudden and severe confusion — is a common complication of hospitalization among people ages 65 and over. As many as 20% of those admitted to hospitals, 60% of those who have certain surgeries, and 70% or more of those treated in ICUs develop delirium, reports the Harvard Women’s Health Watch in its May 2011 issue.

Anything that disrupts normal brain function can cause delirium, including inflammation, infection, and substances that interfere with brain chemicals (neurotransmitters) that communicate between nerve cells. One major pathway involves the neurotransmitter acetylcholine: if blood sugar levels fall too low or the brain doesn’t receive enough oxygen, acetylcholine levels can plunge. Also, many medications can trigger delirium, including narcotic painkillers, sedatives, sleeping pills, and certain drugs used to treat high blood pressure, incontinence, and allergy.  

About 40% of delirium is preventable. Some hospitals have adopted prevention programs. Families also have an important role to play. Family members are often the only ones to see a loved one throughout an illness, hospitalization, and rehabilitation, notes the Harvard Women’s Health Watch. Here are some things the family can do to help prevent or limit delirium:

Consult a geriatric specialist. Not all surgeons know about delirium. If an older patient is considering hip replacement or any surgery requiring anesthesia or sedation, advice from a geriatrician can help with planning for medication, pain control, and sleep support.

Make things familiar. Take a few family photos to the hospital or comforting objects such as a blanket or soothing music tape. Talk calmly with your loved one about current events or family activities.

Stay close. Family members are more likely than others to recognize when the patient isn’t behaving normally. If possible, have someone there day and night while the patient is in a state of delirium.

Promote activity. If possible, help your loved one get up and walk two or three times a day. Help them exercise their brains with conversation, crosswords, card games, or other pastimes.

Read the full-length article: “When patients suddenly become confused”

Also in this issue of the Harvard Women's Health Watch

  • When Patients Suddenly Become Confused
  • Food allergies and food intolerances
  • In the journals: Culturally appropriate storytelling may help control blood pressure in African Americans
  • In the journals: A device to prevent heart failure is twice as effective in women
  • Ask the doctor: Is hair straightening safe?

More Harvard Health News »

About Harvard Health Publications

Harvard Health Publications publishes four monthly newsletters--Harvard Health Letter, Harvard Women's Health Watch, Harvard Men's Health Watch, and Harvard Heart Letter--as well as more than 50 special health reports and books drawing on the expertise of the 8,000 faculty physicians at Harvard Medical School and its world-famous affiliated hospitals.