According to a study of patients admitted to a large hospital in Ireland, 20% of patients at any given time were delirious. As a result, this is something that most doctors, at least those working in hospital, see every single day. It’s like seeing the ice-cream truck in Southern Carolina in the middle of July.
Common as it is, the diagnosis and treatment of delirium is hard. In one study in a Mexican hospital, about 75% of patients with delirium remained undiagnosed, and in a study in a Japanese journal, 65% of patients with delirium were misdiagnosed. Imagine being an ice-cream truck driver and only spotting 25% of the kids! You’d have a hard time staying in business.
So, given that this is common yet under-recognized, I’ve put together a top-five list of delirium misconceptions.
Why do doctors treat delirium with more drugs?
First of all, not all cases of delirium are treated with medications. Medications are used in the treatment of delirium when either a) the underlying cause requires medication (e.g., antibiotics for a skin infection that is causing the delirium) or b) when patients have behavior that is disruptive or dangerous to themselves or those around them. More commonly, unnecessary medications are eliminated.
Why Did the Doctor Start Mom on Even More Narcotics When She is Confused?
More likely, the doctor has switched her pain medication from one to another, often with a dose reduction. Another possibility is that your loved ones’ confusion is due to pain, which, in a state of confusion, they are unable to articulate. A trial of increased pain medication is reasonable in this case.
My Dad knows where he is and what his name is – how can he be delirious?
Being oriented to person, place and time does not exclude a delirium. Being delirious is about more than knowing the basics. Disorganized thinking, disorientation, and memory troubles can all be clues. More importantly, though, a diagnosis of delirium requires the assessment of attention, orientation, memory, and thought process at least several times per day in order to capture a possible delirium. His thinking might well be normal at various points in the day, depending on the time of assessment.
Mom is more quiet, she is not confused?
About half of delirium cases are due to so-called hypoactive delirium. Delirious patients are usually either “hyperactive” (Richard Simmons), “hypoactive” (Jeb Bush), or a mixture of both (an example escapes me, but it exists). For patients with hypoactive delirium, this can manifest as refusing to eat or drink, declining participation in exercise therapy or refusing to take medications, or a general withdrawal from others. Rather than simply being quiet, this may actually be a manifestation of something called hypoactive delirium.
Why can’t the doctor find out why my mom is delirious?
There are many reasons for this. By definition, delirium fluctuates, meaning that it varies throughout the day. Depending on the time of assessment, delirium can be easy to miss. Families know their loved ones best, and are much more able to pick up on an acute change or settle change in their loved one’s behavior.