Delirium an insidious, deadly threat to nursing home residents

January 9, 2017

A comprehensive review of research published today in The Journal of the American Osteopathic Association finds delirium to be an often-undiagnosed syndrome, affecting nearly 18 percent of long-term care residents, with a staggering 40 percent one-year mortality rate.

"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," said author Martin Forsberg, MD, an assistant professor in the Department of Geriatrics & Gerontology at Rowan University School of Osteopathic Medicine, who conducted the review.

Delirium is a syndrome of altered mental status characterized by disorganized thinking, deficits in attention and a fluctuating course. The similarity of its symptoms to those of dementia cause delirium to often go undiagnosed or misdiagnosed in elderly patients with dementia.

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

Also important is that, while delirium often has medical causes, it can persist even after the initial medical condition has been resolved.

Prevention is key

"Avoiding non-essential surgery and hospitalizations may decrease the incidence of delirium. Maintaining hydration and minimizing medication exposure may also be an effective means to prevent delirium. Pain can lead to delirium, and we know managing it well can improve outcomes," said Dr. Forsberg.

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 . Use of restraints on those with disruptive behaviors is also linked to delirium.

Family is first-line defense

Delirium often presents with subtle symptoms which may include perceptual disturbance (hallucinations) and worsened disorganized thinking. Families of in long-term care are often in the best position to recognize these changes.

"Osteopathic medicine focuses on the whole person—which can include familial relationships. So, when I hear a geriatric patient's family say, 'Mom is more confused than usual,' I tend to act," says Dr. Forsberg. He added, "Dementia doesn't change suddenly and cause a worsened condition in a week, but delirium absolutely can."

Limited options for treatment

Dr. Forsberg's review found that antipsychotic medications are used successfully to treat delirium in acute care settings. However, those medications are also linked to increased mortality in patients with dementia, which creates a difficult calculus for physicians.

"I think, historically, we have thought of as a relatively benign condition. The data tells us we need to treat it more scientifically and more seriously than we do," he adds.

Explore further: Antipsychotic drugs may not be effective against delirium

More information: Martin M. Forsberg, Delirium Update for Postacute Care and Long-Term Care Settings: A Narrative Review, The Journal of the American Osteopathic Association (2017). DOI: 10.7556/jaoa.2017.005

Related Stories

Antipsychotic drugs may not be effective against delirium

March 23, 2016
A recent review of the medical literature does not support the use of antipsychotic medications for preventing or treating delirium in hospitalized patients.

Antipsychotic medications worsen delirium symptoms and hasten death

December 6, 2016
Antipsychotic medication typically used to treat patients with delirium may be ineffective at best and hasten death at worst, new research shows.

Nurse studies delirium in older patients

October 18, 2016
One of the most distressing things that can happen after an older family member enters the hospital is that they return … different. Before, maybe they were calm and happy, but now they act agitated and angry, or withdrawn ...

Delirium is common in older gastrointestinal surgery patients

January 19, 2016
A new analysis indicates that delirium commonly develops in the older patients who have undergone gastrointestinal surgery. Among 11 studies analyzed, the incidence of postoperative delirium ranged from 8.2 to 54.4 percent.

Delirium in advanced cancer patients often goes undetected in the emergency department

July 25, 2016
A new study indicates that delirium is relatively frequent and underdiagnosed by physicians in patients with advanced cancer visiting the emergency department. Delirium was similarly common among older and younger patients, ...

Acute kidney injury is risk factor for delirium, coma

November 24, 2016
(HealthDay)—For critically ill adults, acute kidney injury is a risk factor for delirium and coma, according to a study published online Nov. 17 in the American Journal of Respiratory and Critical Care Medicine.

Recommended for you

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Why sugary drinks and protein-rich meals don't go well together

July 20, 2017
Having a sugar-sweetened drink with a high-protein meal may negatively affect energy balance, alter food preferences and cause the body to store more fat, according to a study published in the open access journal BMC Nutrition.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.