Delirium - Mental Confusion in Elderly

Delirium, also called acute confusional state, is a serious disturbance of the patient's mental function, characterized by disturbances of consciousness, with reduced concentration, memory alterations, mental confusion and altered perception of the environment. The onset of delirium is usually sudden, evolving within hours or a few days.

Mental confusion is extremely common in the elderly, especially during hospital admissions or hospitalizations.

Delirium
Delirium
 


Delirium is differs from rave

Although they have very similar names, delirium and rave are different things. Rave is a symptom of psychiatric illness, usually psychotic disorders. Rave is a belief or a strong conviction about absurd facts, which go against reason. As an example, we can cite those people who call themselves the reincarnation of Jesus Christ, who claim to have been abducted by aliens, who think television is talking to them or who swear that someone has implanted a chip inside their brain to watch over their thoughts.

It is important to separate charlatans from people with real rave. The delusional patient really believes in the absurdity he is reporting, and as much as you use valid arguments, you will never convince him that your rave is not real. The charlatan in turn is a dishonest person, who consciously invents stories to gain advantages, usually of financial origin.

Symptoms

Delirium is quite different from delirium. The patient with delirium becomes confused and disoriented, both temporally and spatially, having difficulty knowing where he is and recognizing the current date (when asked what year we are in, he may respond somewhat like 1958). The patient with delirium may be more sleepy and lethargic.

There is a loss of ability to concentrate, causing the patient to be unable to pay attention for too long. This is evident when trying to talk to the patient, because the patient is easily distracted, unable to hold a conversation. Changes in recent memory are also common, so the patient can not remember situations that occurred a few hours or days ago.

Disturbances of perception are common. Patients may not recognize your doctor or family members. Episodes of delirium can occur during delirium, such as imagining that you are being pursued or that the medical staff wants to hurt you. There may be simple hallucinations, with shadows or shapes; or complex, like seeing people who do not exist or who have already died. Hallucinations can be visual and/or auditory.

Delirium arises suddenly and develops over a few hours, and may persist for days or months. The fact that it suddenly appears is the most useful feature in the distinction with dementia, which is a slow and progressive set-up. In addition, the delirium is fluctuating, becoming more intense during the afternoon and at night. It is not unusual for a patient with delirium to appear relatively lucid during morning visits, becoming more confused as the day passes. The exchange of the day by night is also typical of delirium. The patient stays awake and agitated every night and spends a good part of the day sleeping.

Unlike dementia, delirium is transient and improves over time.

Causes

It is not known exactly why delirium appears, but the fact is that it appears to be a disease of multifactorial origin. The patient who develops confusional states usually has more than one of the risk factors listed below:
  • Previous neurological disease, such as Parkinson's disease, Alzheimer's disease or stroke
  • Advanced age
  • Prolonged hospitalization
  • Use of various medications, mainly sedatives, anxiolytics, antidepressants or antipsychotics
  • Infections
  • Dehydration
  • Visual or auditory deficiency
  • Chronic diseases in advanced stage
  • Abstinence from alcohol or drugs
  • Low mobility, restricted to bed
  • Sleep deprivation
  • Emotional stress
  • Ache
  • Prolonged use of bladder catheter

Confusional state in patients

Delirium can arise at any age in any type of person. However, it is more common for him to appear in the elderly who are hospitalized in hospitals or in nursing homes. Up to half of the elderly who remain hospitalized develop some degree of mental confusion.

If the patient already has some neurological disease, or if the hospitalization was motivated by some infection, such as pneumonia or urinary infection, the risk of delirium is very high. The more debilitated the patient is, the greater the risk of developing mental confusion.

The hospitalized patient, in addition to being obviously ill, which in itself is a risk factor for delirium, goes completely out of routine, loses the notion of time, often does not follow the day-night cycle, uses several medications and usually stays most of the time, if not all the time, restricted to the bed of the room. Hospital admission is usually a time when several risk factors for the development of a confusional state are present, making delirium an extremely common situation.

When an elderly patient in good condition develops delirium at home, there is usually some hidden cause behind. Elderly people often react differently to infections. Many do not have a fever and may not have very specific complaints. The onset of delirium may be the only tip for an ongoing infection, such as urinary tract infection or pneumonia.

Prevention and treatment

There is no specific treatment for delirium. Treatment should be directed at the disease or condition that is precipitating the confusional state. But more important than treating delirium is to try to prevent it from appearing. To do this, one should:
  • Avoid keeping the patient hospitalized for long periods
  • Properly control pain
  • Avoid overuse of medications
  • Avoid prolonged use of catheters and probes
  • Stimulate the patient not to be restricted to the bed
  • Treat infections in a timely manner

If the patient is confused and very agitated, the use of drugs to calm him and control agitation may be necessary. In extreme cases, the patient may be confined to the bed, especially if the patient is at risk of falling bed or attempting to remove serums and venous medications.

Delirium tremens

Delirium tremens is a condition defined by hallucinations, disorientation, hypertension, tachycardia (acceleration of the heart beats), fever, agitation and sweating caused by drug abstinence, most commonly alcohol.

Delirium tremens is a medical emergency and can progress to cardiovascular collapse or respiratory failure if not treated in time.

The mild withdrawal symptoms occur within 6-24 hours after the last drink, being characterized by tremors, anxiety, nausea, vomiting and insomnia. Severe alcohol withdrawal occurs 10-72 hours after the last drink. Signs and symptoms include visual and auditory hallucinations, whole body tremors, vomiting, sweating, and hypertension. Convulsive crisis may also occur.

Approximately 5% of alcoholic patients who voluntarily or involuntarily stop alcohol consumption suffer from delirium tremens. The picture usually lasts from one to five days and hospitalization is usually indicated to control the situation.

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