“Detecting Hospital Delirium” (Johns Hopkins Health Alert)

Johns Hopkins Medicine publishes “Health Alerts” on a variety of topics. (See www.johnshopkinshealthalerts.com) Here’s a “Health Alert” on hospital delirium published last week.




Detecting Hospital Delirium
June 16, 2008
By Johns Hopkins Health Alerts

The connection between delirium and dementia is still not fully understood, although doctors have known for quite some time that people who experience an episode of delirium and recover are more likely to go on to develop dementia. In this Health Alert, Dr. Michele Bellantoni talks about the signs of hospital delirium.

Delirium is a common and sometimes serious medical condition that often strikes older people during hospital stays. Though delirium associated with dementia, delirium is temporary and the majority of people who get it improve in a matter of days. Michele Bellantoni, M.D., Associate Professor of Medicine and Medical Director, Johns Hopkins Bayview Care Center, explains, “It’s important to understand that unlike dementia, delirium is a temporary problem that can be treated by figuring out the cause and addressing it.”

The American Geriatrics Society estimates that one third of adults over 70 who are admitted to a hospital experience delirium, and the rates are higher for older adults in intensive care and nursing homes.

Delirium is not a psychological response to physical illnesses, as once thought. In fact, new scientific evidence suggests that abnormal biological processes in the brain are at work. A study published in the Journal of Gerontology compared the brain scans of 22 hospitalized patients taken before and after episodes of delirium. In roughly half the patients, decreased blood flow was specific to key regions of the brain known to control attention and orientation, perhaps explaining the inattention and disorientation associated with delirium.

This may also help explain why delirium can be dangerous: People who become delirious spend more recovery time in the hospital, are more likely to die, and are at higher risk for developing long-term cognitive impairment and dementia.

Detecting Delirium — Delirium may be difficult to detect, particularly in people with memory problems or dementia. Be sure to make allowances for certain personality traits — tell the doctor if a loved one is typically restless or introverted, for instance.

There is no universal rating system to help determine if a patient has delirium; however, the reliability of the following criteria tested positively in a study published in the Journal of Geriatric Psychology. Some central characteristics that researchers identified are listed below. Examples of the type of behavior that might indicate each characteristic are also included.

Delirium Symptom 1 — Shifting attention:
Unable to concentrate during conversations
Switches topics frequently
Easily distracted
Completely inattentive

Delirium Symptom 2 — Poor orientation:
Has problems articulating the date
Doesn’t know the days of the week
Doesn’t know where he or she is
Has trouble recognizing family members

Delirium Symptom 3 — Incoherence:
Speech is difficult to understand
Stops in the middle of a sentence
Cannot express thoughts

Delirium Symptom 4 — Restlessness and anxiety:
Jumpy, edgy, or fidgety
Suspicious of others
Anxious and afraid
Requires frequent reassurance

Delirium Symptom 5 — Delusions and hallucinations:
Perception is distorted or completely wrong
Sees shapes or objects incorrectly
Smells scents that are not there

Delirium Symptom 6 — Poor cognition:
Cannot spell simple words backwards
Cannot do simple math
Cannot recognize simple patterns of words or numbers