Delirium is an acute disorder of attention and global cognition, including perception and memory, and is treatable. Learning the differences between delirium and dementia is important for professional and family caregivers, as the diagnosis is missed in more than 50% of the cases.
According to the Alzheimer's Association, dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer's is the most common type of dementia.
Persons who have dementia are at an increased risk of delirium, however, it is important to learn the differences. Risk factors for delirium include dementia, pre-existing brain disease, medications, and age.
Delirium has serious implications for older adults, especially those who are at higher risks. Sometimes referred to as hospital delirium or post-operative confusion, dementia-like symptoms can be alarming to families and often misdiagnosed by healthcare professionals.
Patients who experience hospital or post-operative dementia may exhibit symptoms such as agitation, experience hallucinations or delusions, and often extreme confusion. Conversely, they may become extremely quiet. Often this is accompanied by a rapid decline in one's mental state.
Older adult patients in hospitals or in rehabilitation facilities who have undergone surgery, had an infection, experienced trauma, or spent time in ICU are more vulnerable to experiencing delirium.
Examples of delirium causes (or aggravators) may be untreated pain, dehydration, constipation, fear, and anxiety of a changed environment (such as a hospital setting). Unfortunately, delirium can be aggravated even more in older adults that are hospitalized, then moved to a skilled nursing facility, where they may be at higher risks of infection and other health complications.
Families must be diligent to note any changes in mental state and discuss these immediately with healthcare professionals. Because families will be more familiar with their loved ones' "normal" state (whether that includes any level of pre-existing dementia or not), sharing a baseline of that person's behavior is important to determine changes that are not normal.
Non-pharmacological management of delirium should be the first approach in treatment. This may include having someone sit with the person to aid in helping him/her feel secure, utilizing soft music and touch to provide reassurance and calm. Bring in photographs of loved ones or special memories that may help the person divert attention from strange or new surroundings.
Families should always discuss non-pharmacological treatment before a loved one is administered medications. If they have had any drug previously for such conditions, such as antipsychotic or sleeping aids and their loved one has had an adverse reaction, be sure to let healthcare professionals know this. Your goal is to avoid aggravating the condition and potential side effects of withdrawal.
While dementia and delirium differ, it is important to note that behaviors may be similar and that proper communications tools for care partners will prove critical in responding to their unmet needs and determining a safe treatment plan with the best outcomes possible.
Pam Brandon is President/Founder of AGE-u-cate® Training Institute and a passionate advocate for older adults and those who serve them. She is the creator of the internationally recognized Dementia Live® Simulation Experience and co-developer of Compassionate Touch® training for professional and family caregivers. Pam may be contacted at pam@AGEucate.com.
Johns Hopkins Medicine