Delirium vs Dementia: What Every Caregiver Needs to Know
Agitation, confusion, imagining things that aren’t there. These are common symptoms of dementia, but they can also be signs of a dangerous but treatable condition called delirium. Learning the difference between delirium and dementia is critical if you care for an older adult because delirium, unlike dementia, is a medical emergency that needs immediate evaluation and care. It’s also important because not all healthcare workers are familiar with delirium symptoms, so families are sometimes the first to spot the problem.
According to the American Delirium Society, more than 60% of the 7 million Americans who develop delirium each year during or after a hospital stay are undiagnosed. Proper diagnosis and treatment are crucial because delirium is associated with higher mortality rates, longer hospital stays, the need for more nursing care, and a greater likelihood of developing dementia after a delirium episode.
Symptoms of delirium
It’s hard to overstate how similar the symptoms of delirium and dementia can seem at first glance. Patients who develop delirium may get agitated and even paranoid due to confusion and hallucinations. Other people who get delirium may become quiet and withdrawn or dazed. Still other patients may have “mixed delirium,” in which they rapidly move from dazed to upset or euphoric and back again.
The telltale difference between dementia and delirium is that while dementia usually gets worse slowly over months or years, a full-blown delirium episode can come on in a matter of hours or days. This rapid onset of symptoms is a major difference between delirium and dementia. If you see an abrupt change in your parent’s behavior or mental functioning, that’s a big red flag for delirium.
Whatever the new behavior looks like, there are noticeable changes in the person’s behavior and mood compared to normal—including confusion, memory lapses, anxiety or lethargy, garbled speech, and a seeming inability to pay attention to what’s happening. Dr. John Burton, the director of the Johns Hopkins Geriatric Education Center, writes that the 3 key indicators of delirium are:
- Rapid onset of fluctuating symptoms over a few hours or days
- Distractibility or an inability to pay attention to one’s surroundings
- Cognitive problems such as a change in consciousness or trouble thinking clearly
When you see these sudden changes, get your parent or relative checked for delirium right away, before the problem spirals out of control and causes lasting harm.
Risks of unrecognized or misdiagnosed delirium
The Mayo Clinic says that the sooner treatment for delirium begins, the shorter the patient’s recovery time may be. Without treatment, delirium can lead to:
- falls, broken bones, and head injuries.
- long-term cognitive dysfunction and memory loss.
- misdiagnosis with dementia and placement in memory care.
- post-traumatic stress disorder.
- premature death.
Many people who recover from delirium struggle for weeks or months with memory loss and anxiety.
Causes and risk factors for delirium
The exact cause of delirium isn’t known. According to a report on delirium in The Atlantic, it’s an area of medicine that doesn’t get a lot of study. What doctors do know, based on their own observations and patient cases, is that at least a dozen health conditions that can trigger delirium, many medications can cause it, and some illnesses and situations increase the risk of a delirious episode.
What can cause delirium in seniors?
The Mayo Clinic says fevers, infections, dehydration, poor nutrition, pain, metabolic imbalances, alcohol, exposure to toxic substances, extreme stress, and sleep deprivation can all cause delirium as well.
Anesthesia for surgery and some medications can trigger delirium or make it worse. Some types of sedatives, painkillers, blood pressure medications, and muscle relaxants can cause or contribute to delirium, according to the Alzheimer’s Association, and some over-the-counter anticholinergic drugs to treat allergies can cause delirium and even psychosis symptoms in older adults. Specific drugs that may cause delirium in seniors include but aren’t limited to:
Your parents shouldn’t stop taking any prescribed medications without talking to their doctor first, even if the drugs are on this list. The doctor will have to weigh the risks and benefits of changing or stopping those medications, based on your parents’ health history and risk factors. Still, experts recommend reviewing your loved one’s medications with his or her doctor at every visit to reduce the likelihood of bad drug reactions or interactions. And as a family caregiver, you can keep an eye on your parents’ behavior and report any dramatic or sudden changes to their doctor.
Which seniors are most at risk for delirium?
Dementia is one of the health problems that can put people at increased risk for delirium. It can be hard to spot delirium in dementia patients – the key is to watch for sudden changes in behavior, such as withdrawal in a previously agitated and active person or vice versa. Other risk factors for delirious episodes are:
- a history of delirium.
- a history of strokes.
- being on a ventilator.
- complex health problems.
- hearing loss (hearing aids can help reduce or prevent delirium in some patients).
- heavy sedation.
- hospitalization in the intensive care unit.
- hospitalization for longer than a few days.
- increasing age.
- Parkinson’s disease.
- vision problems (delirium patients sometimes improve when wearing their glasses).
These experiences all elevate the risk of delirium, but anyone can experience it under certain circumstances.
Getting the right care when a loved one has delirium
In older adults, especially those with underlying health problems, delirium is a medical emergency that needs immediate attention for the best chance of recovery.
When your parent has delirium at home
The VA recommends that you take your parents to their doctor right away if they suddenly:
- can’t focus on what’s going on around them.
- can’t make eye contact with you.
- start mumbling.
- start saying things that don’t make any sense.
- have visual or auditory hallucinations.
- get upset for no apparent reason.
When your parent has delirium in the hospital
If your parent is already in the hospital and shows any of these symptoms, tell a nurse or doctor right away. You can reduce the risk of a delirious episode or help a delirious parent recover faster by following these tips from the Hospital Elder Life Program, a group dedicated to helping hospitals prevent and treat delirium in seniors:
- Bring a list of every medication and supplement your parent takes, along with doses, or bag up all their meds and bring them with you so staffers can read the labels.
- Create a medical information sheet you can give to the hospital staff with their health history, drug allergies, medications, and other information. In their book, The Gift of Caring, Marcy Cottrell Houle and Dr. Elizabeth Eckstrom also recommend keeping a written baseline health status for your loved one, updated at each doctor visit and signed by the doctor. This can be a short paragraph that describes his or her overall physical health, cognitive state, activity level, continence status, and balance and falls risk, and any previous episodes of delirium, illness and hospitalizations. In an emergency, this information can help doctors and nurses determine whether your loved is experiencing delirium and if so, treat it appropriately.
- Help your parents stay connected to their surroundings by making sure they have their eyeglasses, dentures, and/or hearing aids.
- If you can bring a favorite blanket or other item from home, your parent may be more relaxed and less prone to agitated delirium.
- Keep your voice calm and update your parent on what’s going on during the day to avoid confusion.
- At the same time, keep instructions and explanations simple so your parent doesn’t feel bombarded with information while they’re ill or confused.
- Set a schedule with other family members and close friends so that your parent has company throughout the day—and around the clock if he or she is having severe delirium.
- HELP also recommends massage to help delirium patients relax, if they’re receptive to it.
- You can also ask your parent’s nurse or the hospital’s social workers if they use the HELP program in their hospital. This delirium-prevention program uses trained staffers and volunteers to carefully monitor patients for delirium risk, check in with these patients frequently to make sure their care is on track, and help with the transition to home after discharge. (You can find a list of HELP-affiliated hospitals here.)
The best defense against delirium is good care
In an ideal world, all seniors who are at risk for delirium or who have experienced a delirious episode would have a geriatrician as their doctor.
Geriatricians and delirium care
These senior-health specialists are up to date on which medications affect older adults more strongly than younger adults and which medicines don’t work well or safely as we age. A geriatrician can also prevent or fix what’s called polypharmacy, which happens when multiple doctors prescribe a patient different drugs that interact poorly or cause confusion. Because of their senior-health focus, geriatricians can help patients avoid or recover more fully from delirium.
Geriatricians also focus on the emotional needs of people who are coming to terms with needing extra care, and they work with family members and other caregivers to create a safe living environment for their patients. That can include therapy for delirium-induced PTSD and memory problems, and recommendations for reducing confusion at home or in the hospital. The American Geriatrics Society’s Health in Aging website recommends that seniors with health problems that seriously impair them or make them frail should see a geriatrician. So should seniors whose family caregivers are over-stressed by providing care. Your family doctor may be able to refer you to a geriatrician. You can also use the Health in Aging search tool to find nearby family physicians and internists who are certified in geriatrics.
Geriatric care managers and delirium prevention or recovery
Another option for families with a senior who’s had delirium, has complex health issues, or has dementia plus other health problems, is to hire a geriatric care manager. A consistent routine, familiar surroundings, and clear communication are vital to helping seniors recover from delirium and reduce the risk of future episodes. A geriatric care manager can arrange for a safe living environment that provides social contact, a proper diet, and some sort of exercise or regular activity.
He or she can also make sure that everyone who cares for your parent or loved one knows the medication schedule, menu plan, daily schedule, and symptoms or behaviors that warrant a call to the doctor. This type of personalized, professional care management is especially helpful for seniors whose family lives far away, and it’s crucial for seniors with round-the-clock care needs and multiple caregivers. To find a qualified geriatric care manager, ask your doctor or geriatrician for referrals. You can also use the Aging Life Care Association site to find more information and certified care managers in your city or town.
In-home, assisted living, and respite care options
Whether or not your family uses a geriatric care manager to help keep track of your parents’ health, it’s important to make sure that everyone who cares for your folks knows how to spot the signs of delirium. If your parents live at home, talk to their in-home caregivers and respite care providers about what they should do in case of delirium. If your parents are in assisted living or a nursing home, ask the staff how they’re trained to handle suspected cases of delirium. These conversations are especially important if your parents have already had one or more delirious episodes, because they’re at higher risk for another episode later on.
Finding the right team to care for your parents can be a challenge. If you need help locating caregivers in your area, check out SeniorAdvisor.com’s reviews. You can also contact trained senior living advisors at 1-800-805-3621 for detailed information about senior-care services near you.