Illusions and Delusions-Part III-Medical Condition Delirium

Delirium is a syndrome of disturbed consciousness, cognition and perception that develops over a short period of time and tends to fluctuate during the course of the day and is caused by one or more physical conditions. Delirium results from a disturbance in the neurotransmitters (chemical messengers) in the brain that control consciousness, thinking and behavior.

The hallmarks of delirium are an abrupt onset of depressed level of consciousness, alterations in memory and behavior, and sometimes hallucinations. It is more common in older adults, possibly due to normal age-related changes in the nervous system and brain, diminished eyesight and hearing associated with age, greater use of medications in elderly patients, and diseases that injure the brain and predispose to delirium. For example, it is known that the condition dementia places a person at higher risk for developing delirium than people who are not afflicted with dementia.

Researchers at medical centers have been looking into this phenomenon for years. One POTENTIAL PREVENTATIVE STUDY came from the group at Yale University Medical Center who reported in NEJM. (See: Inouye et al. NEJM. 1999; 340:669-676.). The group found that in a group of hospitalized general medicine patients aged 70 or above who had no delirium at admission, 10-15% of the group went on to develop delirium after admission. They identified the risk factors for delirium as related to visual impairment, severe illness, cognitive impairment and abnormal renal function blood tests.

They attempted an intervention program, Elder Life Program, which they hoped would reduce the risk of delirium. This intervention employed a specialist in geriatrics and trained volunteers who instituted the following activities:
Activities to stimulate the mind.
Special efforts to keep patient oriented while in hospital.
Avoiding excessive bed rest and keeping patient mobile.
Promoting sleep without the use of hypnotic drugs and ensuring the environment was conducive to sleep.
Reminders to bring and use communication devices (e.g. hearing aids, eyeglasses etc.).
Providing aids to promote communication such as magnifying glasses, large print glasses, clearing wax from ear canals.
A protocol to detect and treat low fluid intake (dehydration).

This intervention reduced the incidence of delirium by 40%, as well as reduced the number of days of delirium and the number of episodes of delirium. Lower risk patients benefited most from this program. Those with marked dementia did not benefit in any appreciable way.

Measures to identify and prevent delirium from occurring have been identified, though it will not be eliminated. More basic clinical and neuroscience investigation are needed to help reduce the incidence of this troubling issue so that many elderly can enhance the quality of their lives, not fearing entering a hospital and undergoing clinical treatment because of potentially aversive effects of hospitalization. Let us hope that the current difficult fiscal times will not interfere with such programs of proven value.

Illusions and Delusions in the Elderly-Part I
Illusions and Delusions-Dementia Delirium-Part II


Harold Rubin, MS, ABD, CRC, Guest Lecturer
April 19, 2003

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