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Delirium is a temporary but serious condition that causes sudden confusion, emotional disturbances, and unusual behavior. When it occurs in a hospital setting, such as the emergency department (ED) or the intensive care unit (ICU), it is known as hospital-acquired or hospital-induced delirium.

Hospital delirium is common in older adults. This article explores what caregivers need to know to help someone at risk of hospital delirium.

Delirium affects a person’s mental state, along with their attention, consciousness, perceptions, and reasoning.

The symptoms can vary a lot from one person to the next. They may also differ from one episode to the next, or evolve over the course of a single episode.

Some common symptoms of delirium are outlined below.

Disturbances in attention

A person with delirium might find it difficult to focus their attention. They might have trouble answering questions or shifting topics, or they might get distracted easily.

Disturbances in awareness

Delirium can affect how responsive a person is to their environment. Some people with delirium appear withdrawn or indifferent. Others experience agitation, paranoia, or hallucinations.

Disturbances in cognition

Cognition refers to thought processes. Delirium can cause confusion and disorientation. It can also cause challenges with memory, speech, or other everyday activities such as walking, reading, or eating.

Other symptoms

Some other symptoms of delirium include:

  • difficulty sleeping
  • mood swings
  • personality changes
  • rambling
  • restlessness

If you’re caring for someone with another condition that affects their mental state, such as dementia, it might be harder to identify signs of hospital delirium. A key difference is that delirium comes on suddenly, while dementia develops gradually. Consult their doctor to learn more about potential warning signs.

How long does hospital delirium last?

Hospital delirium develops quickly, usually over hours or days. A single episode can last from a few hours to a few months.

For many people, delirium results in a longer hospital stay and a risk of additional long-term complications.

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To treat hospital delirium, doctors will first try to address the underlying cause. What causes delirium can vary from one person to the next.

A doctor will suggest treatments based on contributing factors. In the case of an infection, for example, a doctor would prescribe antibiotics.

Supportive care can make the person more comfortable and prevent further complications. Supportive care might involve avoiding or adapting usual treatment strategies. Examples include not using physical restraints or urinary catheters.

Sometimes, a doctor may prescribe medication to alleviate symptoms, such as agitation, restlessness, paranoia, or hallucinations.

If you suspect a loved one is delirious, express your concerns to medical staff as soon as possible. Remember that you know your loved one best.

You can try to gently redirect your loved one by asking them to look out the window at the weather or talking about recent events. Take the time to explain why they’re in the hospital. If they don’t respond, aim to be a comforting physical presence.

It will likely be distressing to see your loved one in this state. Their words and actions might not align with the person you know. They might become angry at you or forget who you are.

It’s not your fault. Try to remain calm and accept your own emotions. It’s typical to feel fear, frustration, embarrassment, sadness, or guilt in this situation.

If you’re struggling, ask to speak with a hospital social worker, chaplain, or counselor.

There’s no single cause of hospital delirium. Some people may experience one or several triggers in a hospital setting. For others, there’s no identifiable cause.

Potential causes of hospital delirium include:

  • anxiety and depression
  • drug or alcohol withdrawal
  • infections
  • medical conditions
  • pain
  • poor sleep
  • side effects of medication
  • surgery
  • lack of oxygen
  • low blood sugar

Some people are at an increased risk of experiencing hospital-induced delirium. These include people who:

  • are over the age of 70
  • are male
  • have dementia or other cognitive impairments
  • have hearing or visual impairments
  • have multiple health conditions
  • have experienced delirium before
  • have reduced organ function

The conditions of someone’s hospital stay may also increase their risk. Rates of hospital-induced delirium are higher for people in ICU or on mechanical ventilation.

Hospital delirium in the elderly

Hospital delirium is extremely common in people over the age of 65. For example, a 2017 study of 200 older individuals found that 20% experienced delirium after spending 12 hours in an emergency department.

Similarly, a 2019 study of 1,507 older people who had been admitted to ICUs in the United Kingdom reported that about 21% experienced probable or diagnosed delirium.

Older people are at an increased risk due to age-related factors such as:

  • physical frailty
  • chronic illnesses
  • poor organ function
  • increased reliance on medications
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Researchers estimate that almost 40% of cases of hospital delirium are preventable. There’s much that hospital staff can do to help prevent delirium. But caregivers can also play an important role.

Role of hospital staff

There are models that enable healthcare professionals to predict the chances of delirium in a patient. These models consider and weigh various risk factors. Results may suggest whether doctors should take preventive measures.

Environmental factors can play a role in the development of delirium. Hospital staff can help create an environment that can reduce the risk. They may consider the following:

  • Keep nighttime noise and light to a minimum.
  • Schedule rounds to avoid disrupting sleep.
  • Avoid using physical restraints if possible.
  • Avoid using indwelling catheters if possible.
  • Allow family members to stay overnight.

A doctor may consider medication to help prevent delirium. A 2016 clinical trial suggests that the drug dexmedetomidine might lower the risk of delirium in patients on ventilators. Other research from 2016 found a link between melatonin and lower rates of hospital delirium in older adults, but recent trials did not support the link.

Some medications that doctors commonly prescribe in the ICU are linked to a higher risk of delirium. If someone may be at high risk for delirium, doctors may consider avoiding these medications. Examples include:

Role of caregivers

Preventing hospital delirium can be a challenge for caregivers. Certain aspects of the hospital environment and the care provided are beyond your control.

There are still ways in which you can help your loved one:

  • Initiate conversations with them.
  • Orient them after a medical procedure such as surgery.
  • Help them get up and walk around when possible.
  • Make sure they have their personal items, such as hearing aids or glasses.
  • Encourage proper nutrition and hydration.
  • Make sure they’re getting enough sleep.

Know that, as a familiar presence in an unfamiliar setting, you’re already reducing your loved one’s risk of hospital delirium.

Are there long-term effects of hospital delirium?

Recovery time typically depends on the person’s health before the episode. Most people can regain their regular abilities within a period of weeks or months. But those with serious health conditions, such as dementia, might never fully recover.

Can COVID-19 cause hospital delirium?

Yes, COVID-19 has been linked to hospital delirium. A 2020 study of 852 people admitted to a hospital for COVID-19 found that 11% developed delirium over the course of their stay.

A 2022 study of 927 older adults admitted to the hospital for COVID-19 found that about one-third developed delirium during their stay.

The above study was conducted in the early months of the pandemic, but more recent studies have shown that delirium is still common in older adults who are hospitalized for COVID-19.

Can hospital delirium lead to death?

Hospital delirium is associated with an increased risk of death. In the 2019 study cited above, delirium in older adults was linked to a greater risk of dying in the hospital. And according to 2022 research, ICU delirium is associated with a two- to four-times increase in the overall risk of death.

Hospital-induced delirium is a condition that causes disruptions in awareness, attention, and cognition. It develops suddenly and may last for several hours or days.

As a caregiver, you know your loved one best. While it’s not always possible to prevent delirium, you can aim to be a supportive and familiar presence in a hospital setting.

Ask your loved one’s doctor what you can do to support your loved one following an episode of delirium. Chat with your loved one, help them move around, and ensure they’re comfortable. Promote healthy habits by ensuring they get enough food, liquids, and rest.