Understanding Hospital Delirium: Key Information for Caregivers
Preventing and Treating Hospital Delirium in Older Adults with Dementia
Hospital delirium, a common complication among older adults, particularly those with dementia, can lead to worse outcomes, prolonged hospitalizations, and increased healthcare costs. This distressing condition, which affects cognition, causing sudden confusion, emotional upsets, and behavioral changes, can seriously affect a person's outlook and lead to prolonged hospital stays, increased risk of complications, functional decline, higher mortality rates, and an increased risk of developing dementia later in life.
Fortunately, effective strategies to prevent and treat hospital delirium in older adults with dementia combine early detection, non-pharmacological interventions, and cautious medication use tailored to individual needs.
Early Screening and Detection
Early screening and detection using validated tools integrated into electronic health records (EHRs) can help identify delirium risk promptly. EHR alerts and best practice advisories can prompt clinicians to initiate prevention steps immediately.
Non-Pharmacological Interventions
Non-pharmacological interventions play a crucial role in managing hospital delirium. These include orienting communication and cognitive stimulation to reduce confusion, ensuring the use of assistive devices like hearing aids and glasses to improve sensory input and communication, promoting early mobilization through physical and occupational therapy, maintaining hydration and preventing constipation, and creating calm, familiar environments that reduce psychological stressors linked to delirium.
Avoidance of Delirium-Provoking Medications
Avoidance of delirium-provoking medications such as certain sedatives and anticholinergics, which can worsen delirium or dementia symptoms, is also essential.
Medication Strategies
Medication strategies should be used with caution. Antipsychotics should be a last resort for managing severe distress or agitation related to delirium or dementia, given risks like sedation, falls, and worsening cognition. Drugs approved for Alzheimer's (donepezil, rivastigmine, galantamine, memantine) may help address cognitive symptoms and some behavioral aspects but do not treat delirium directly. Careful review and adjustment of dementia medications may be required during delirium episodes.
Focused Nursing Care and Staff Education
Focused nursing care and staff education are crucial. Nurses' understanding of delirium risk factors, including recognizing that dementia can mask delirium, affects early identification and management. Training on validated screening tools (e.g., CAM-ICU) can enhance care quality.
Continuous Quality Improvement
Continuous quality improvement using compliance dashboards and feedback systems integrated into care routines can monitor adherence to delirium protocols and improve outcomes.
In summary, a multi-component approach combining timely screening with supportive, non-drug strategies and cautious medication use, informed by specialized nursing care and supported by technology like EHRs, is most effective for preventing and treating delirium in older adults with dementia in hospital settings. Encouraging social engagement, such as conversations, visits from loved ones, or participation in group activities, can help prevent hospital delirium. Encouraging a balanced diet and regular fluid intake can prevent dehydration and nutrient deficiencies that exacerbate delirium. Providing sensory stimuli such as familiar music, photographs, or tactile objects can help maintain cognitive engagement. Creating a calm environment with reduced noise, proper lighting, and minimal disruptions can also help prevent hospital delirium.
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