In the times before the pandemic, my doctor friends and I would enjoy getting a beer after work. We got to discussing what the most common problems are that we deal with in hospitalized patients.
Here were some of their responses:
- Shortness of breath
- Nausea
- Constipation
- Disagreements between family members
- Sending someone home despite safety concerns
You can read about those other things here. The one thing that nobody mentioned was confusion. But if you ask family members, this is one of the most upsetting problems to happen to a loved one. It more commonly happens in the hospital, but can occur at home as well, and it is actually a common reason for coming to hospital. The difficulty visiting family members due to pandemic
The medical term for confusion is delirium. It’s reversible in about half of cases. In cases where a cause can be identified, delirium is commonly due to medications, infection, or dehydration. Commonly, it is due to all three (or more). In addition to this, there are a whole range of problems directly related to the effects from the cancer itself (e.g., a tumor causing high calcium levels) that can contribute to delirium.
What delirium is not
Delirium is totally different from dementia, which is a persistent difficulty with memory that often long precedes going to hospital. People with dementia are at higher risk of delirium, but the two processes are distinct.
What does delirium look like?
The most common clues are:
- Inability to pay attention
- Seeing (more commonly) or hearing (less commonly) things that don’t exist (hallucinations)
- Restlessness, agitation or combative behavior
- Calling out, moaning or making other sounds
- Being quiet and withdrawn — especially in older adults.
- Slowed movement or lethargy.
- Disturbed sleep habits.
- Reversal of night-day sleep-wake cycle.
How is Confusion Treated in Hospital?
If you said, “by getting the hell out of there,” you would be partially correct – an unfamiliar environment is a common contributor to delirium. However, this is usually not advisable or practical. Treating delirium involves identifying whether there is a culprit cause, and then treating it. (e.g., antibiotics for pneumonia). Disruptive or dangerous behavior that can harm patients or others also requires management, usually with medications.
Other treatment strategies include changing or reducing the dose of medications, or by providing a trial of fluids or antibiotics for a few days.
What can I do if my loved one is confused in hospital?
Check out this graph. This is from a 2020 Japanese study that saw rates of delirium roughly triple after Covid visitor restrictions were initiated in a hospital’s emergency department.
Interestingly, this increased rate of delirium persisted regardless of age, whether or not the patient had a previous diagnosis of dementia.
So, what can you do? Visit your loved one, if possible, because this can help get them oriented to their environment. Bring their hearing aids and glasses to help increase orientation to their new environment. If they can walk or stand, and if their team feels it is safe to do so, get them moving. All together, and especially for elderly patients, these simple actions can reduce the chances of a first episode of confusion in hospital by about 30%.