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How you can protect your ageing parent from delirium

If you have elderly parents or are caring for an elderly person, you will need to know about delirium. It’s a surprisingly common condition that can occur suddenly in older people.

A recent Australian study found one in ten people aged over 70 had been experiencing delirium before they arrived at hospital. Another one in ten developed delirium while in hospital – which means one in five elderly in hospital were suffering from delirium.

What is delirium?

Dementia is a condition where a person’s memory, thinking, understanding or judgement can be affected. It gets worse with time. People who have dementia are at a higher risk of developing delirium. Delirium usually starts suddenly and can be frightening for the person experiencing it, as well as for those around them.

What are the symptoms of delirium?

Some examples of symptoms include:

  • Diminished awareness of surroundings
  • Uncertainly about location
  • Inability to understand conversation and speak clearly
  • Vivid, often frightening dreams that continue once awake
  • Auditory hallucination
  • Agitation and restlessness
  • Fear that others are trying to cause harm
  • Feeling drowsy and slow
  • Sleeping during the day but being awake at night
  • Rapid mood swings that vary from scared and anxious to depressed or irritable
  • Confusion that worsens in the evenings

What causes delirium?

Delirium is fairly common among older people. Particularly those with memory problems or dementia or who have poor hearing or vision, or recovering from injury or illness.

Some of the most common causes of delirium include:

  • Infection of the bladder, chest or brain
  • Fever
  • Medication side effect
  • Dehydration
  • Liver or kidney problems
  • Cessation of drug or alcohol use
  • Major surgery
  • Epilepsy
  • Terminal illness

How to treat delirium?

If your parent develops confusion out of the blue, urgent medical attention should be sought.

Often, they are too confused to tell the doctors about their condition and history and it is helpful if you are on hand to relay this information, along with a list of medications they are taking.

Treatment is aimed at correcting the underlying cause. For example, infection would be treated with antibiotics.

What can you do to help?

Make sure your parent is safe and arrange for a doctor to review their health status without delay. If you are worried, take them to the local hospital emergency department or arrange for an ambulance.

It can be helpful to do simple things like:

  • Removing excess noise and making sure the person sleeps well, eats and drinks enough, has familiar people around.
  • Remind the person about who you/the care staff are, what day and time it is (e.g. nearly lunch time) and where they are.
  • Open curtains and blinds for natural light, and so they can see where they are and what is happening.
  • If they talk about things or people you cannot see, provide reassurance about their safety. Respond to their emotions (e.g. fear). Don’t argue about facts.
  • Stay with them if your presence is calming or reassuring. You might find it distressing to be present, so enlist help and support from your other family, friends and health care staff.
  • Talk to them in a calm, clear and simple way; perhaps about familiar family, friends, events and, with children, their favourite toys/stories/movies etc. Avoid complex questions and conversations.
  • Respond calmly, even if they talk about things or events you cannot see or are unfamiliar with.

If they become agitated try not to restrict their movements. It is important for a person with delirium to continue to move, walk and exercise, if possible.

How to prevent delirium

You can minimise the risk of delirium with these simple interventions:

Dehydration: Encourage drinking, unless fluids are restricted for some reason.

Immobility: To the extent possible, help the person go for walks or encourage him or her to move arms and legs in bed.

Sleep deprivation: When disrupted sleep cycles are a problem, the medical team can decide not to wake the person at night to check vital signs if it’s not essential. Volunteers — or families — can alert the staff to sleep problems. They can also move the person toward a normal sleep cycle by helping the patient stay awake during the day and creating a quiet, peaceful sleep environment in the evening. HELP volunteers use aromatherapy and hand massage to soothe patients.

Hearing impairment and vision impairment: “A lot of people don’t bring their hearing aids [to the hospital] because they’re afraid they’re going to get lost and they’re expensive,” Duncan said. But when families know about delirium and hearing impairment as a risk factor, they can make sure their loved one has hearing aids in place and a supply of batteries. The same is true with glasses and dentures, to help the person stay attuned to the environment and communicate clearly.

Cognitive impairment: Ensure the person is active and engaged. Encourage their personal interests and abilities and help them access music, tablet computers loaded with games, books, audiobooks and even craft supplies, such as knitting baskets.

Families know something that’s even more important than preventing, detecting and managing delirium and that’s their loved one’s normal personality and normal cognitive abilities. Knowing those things place families in the important role of being the first to notice changes.

Find out more at http://www.delirium.org.au/community-info

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