Delirium is a syndrome of altered mental status characterized by
disorganized thinking, deficits in attention and a fluctuating course.
The similarity of its symptoms to those of dementia cause delirium to
often go undiagnosed or misdiagnosed in elderly patients with dementia.
The most acute symptoms typically last one week; however, it can
take weeks or months for patients to get back to baseline. Persisting
delirium can accelerate dementia, making it difficult to accurately
determine whether the patient still has delirium or a worsened baseline
‘Delirium is an often-undiagnosed syndrome, affecting nearly 18% of long-term care residents, with a staggering 40% one-year mortality rate.’
Also important is that, while delirium often has medical causes, it
can persist even after the initial medical condition has been resolved.
A comprehensive review of research published today in The Journal of the American Osteopathic Association
finds delirium to be an often-undiagnosed syndrome, affecting nearly 18% of long-term care residents, with a staggering 40%
one-year mortality rate.
"It is unclear whether delirium itself causes deterioration in brain
functionality that ultimately can result in premature death, or if
delirium is a symptom indicating a mind and body already in decline,"
said author Martin Forsberg, an assistant professor in the
Department of Geriatrics & Gerontology at Rowan University School of
Osteopathic Medicine, who conducted the review.Prevention is key
"Avoiding non-essential surgery and hospitalizations may decrease
the incidence of delirium. Maintaining hydration and minimizing
medication exposure may also be an effective means to prevent delirium.
Pain can lead to delirium, and we know managing it well can improve
outcomes," said Dr. Forsberg.
Some studies noted links to environment: when there was no clock in a
patient's room, patients were twice as likely to have disruptive
behavior. Patients without a phone in their room were three times as
likely to have disruptive behavior. Use of restraints on those with
disruptive behaviors is also linked to delirium.
Family is first-line defense
Delirium often presents with subtle symptoms which may include
perceptual disturbance (hallucinations) and worsened disorganized
thinking. Families of elderly patients in long-term care are often in
the best position to recognize these changes.
"Osteopathic medicine focuses on the whole person - which can include
familial relationships. So, when I hear a geriatric patient's family
say, 'Mom is more confused than usual,' I tend to act," says Dr.
Forsberg. He added, "Dementia doesn't change suddenly and cause a
worsened condition in a week, but delirium absolutely can."
Limited options for treatment
Dr. Forsberg's review found that antipsychotic medications are
used successfully to treat delirium in acute care settings. However,
those medications are also linked to increased mortality in patients
with dementia, which creates a difficult calculus for physicians.
"I think, historically, we have thought of delirium as a relatively
benign condition. The data tells us we need to treat it more
scientifically and more seriously than we do," he adds.