Dementia, Health care

Delirium or Dementia?

I subscribe to several blogs and websites about caregiving the old-old. One came up this week with an article that stopped me in my tracks. Did this, finally, explain what happened three years ago when my sister and I took our mother to the E.R. with, yes, a suspected bowel blockage that was not? Because of her age, I suppose, the E.R. doctor said “maybe there might be a small blockage” on the CT scan, and he admitted her. She stayed three days. And talked about it for the next two years. (Read about it here.) It is why I was NOT going to take her to the E.R. two weeks ago for the same non-existent reason. (Read about that here.) We have all blamed the lorazepam she was given perhaps too high a dosage of, considering her age and size. But what spurred the staff to give it to her in the first place? And why did it cause her to be completely off her rocker for so many hours. And why did the experience continue to traumatize her for months and months?

And now this article, Delirium vs. Dementia, by Leslie Kernisan, MD, that makes complete sense. There is much more in the article—and I encourage anyone who cares for a person with dementia, Alzheimer’s, or any type of cognitive impairment to read it in its entirety—but here is an excerpt.

Delirium is a state of worse-than-usual mental confusion, brought on by some type of unusual stress on the body or mind. It’s sometimes referred to as an acute confusional state,” because it develops fairly quickly (e.g., over hours to days), whereas mental confusion due to Alzheimer’s or another dementia usually develops over a long time.

The key symptom of delirium is that the person develops difficulty focusing or paying attention. Delirium also often causes a variety of other cognitive symptoms, such as memory problems, language problems, disorientation, or even vivid hallucinations. In most cases, the symptoms “fluctuate,” with the person appearing better at certain times and worse at other times, especially later in the day.

Delirium is usually triggered by a medical illness, or by the stress of hospitalization, especially if the hospitalization includes surgery and anesthesia.

It’s much more common than many people realize: about 30% of seniors experience delirium at some point during a hospitalization…

Despite the fact that delirium is extremely common, it is often missed in seniors, with some reports estimating being missed 70% of the time. That’s because busy hospital staff will have trouble realizing that an older person’s confusion is new or worse-than-usual. This is especially true for people who either look quite old – in which case hospital staff may assume the senior has Alzheimer’s – or have a diagnosis of dementia in their chart.

I offer it for the education of the masses. One of things my sister and I learned from that experience, is never ever leave an elderly person alone in a hospital. However exhausting it is, if an experience like this happens in your absence, you will be more exhausted dealing with it later; maybe forever. And yes, they had instructions to call us if her status changed in any way. They did not.

9 thoughts on “Delirium or Dementia?”

  1. One of the key lessons I learned along the way in my calling is the importance and power in “distinctions”. There is a hoary old anecdote about Eskimo’s being powerful in their environment because they have umpteen language distinctions for snow. While now largely debunked in its specific authenticity, it is never-the-less true in its point. The better and finer distinctions we can make between things or inside a thing, the more able we are to be effective and cope well.

    What I found comforting in your blog – and I’m thinking you did, too, even if after the fact – is that there are distinctions to be made and that somebody understands, below the level of “old age” or “dementia”; distinctions that are important and help care-givers of all sorts intervene, support, and self-care more effectively. What is not so comforting is Donna’s point about the very places that should be masterfully fluent in those distinctions, don’t seem to be.

    The value in your sharing is that it helps that many others learn about those distinctions – which I, for one, may never have run across otherwise – and so help others better. And maybe even help myself some day when I see those tiny giraffes running across the ER.


    1. Ah. The tiny giraffes. Did you learn about that from my blog? Charles Bonnet Syndrome? That discovery was huge for my mom. When I found out it was a thing, and with a name, she stopped obsessing about it. Sometimes she says something, joking about it, and it’s clear it happens more often and she says nothing about it.


      1. And thank you for your words on “distinction.” I have often told her, when she is obsessing about this and that ailment and its (unknown) cause, “What difference does it make? It just is.” It covers the fact that I have no way of knowing the cause, and don’t see the point in speculating. But it’s probably of extreme urgency to her to know. I still don’t know what to do about the fact that I do NOT know, however.


  2. Very good connection – reconnection to this material. It is true! This does happen! AND it can also be treated by skillful, palliative care professionals who can diagnose accurately.


  3. Thank you for sharing this important information. I’m only sorry you didn’t come across this article before your mom was admitted to the hospital. At least you have some answers to the mysterious changes you’ve been dealing with.


    1. Like parenting, shepherding the old ones, and the sick ones (as you well know), is on-the-job training. What I can do is pass it on; maybe one less thing for someone else to learn after the fact. There will always be plenty more unknowns.


  4. I learned about this phenomenon when my father was in the hospital several times during the last two years of his life. It goes by a few different names: ICU psychosis, hospital-induced psychosis, hospital-induced delirium, etc. It doesn’t just affect the elderly, but they are particularly susceptible to it. My dad (late seventies at the time) had bizarre hallucinations and became paranoid. As soon as he was released from the hospital and returned back home, the symptoms would disappear. We were with him almost all the time when he was in the hospital and would re-orient him to reality, but the longer the stay, the worse his symptoms became, regardless of our presence. It was very scary and bewildering to witness, and I was surprised that none of the doctors or nurses told us what was happening since it seems that hospital-induced psychosis is a common occurrence. I didn’t learn about it until a friend who is a hospital chaplain told me what it was.


    1. Thank you, Donna. I appreciate hearing about your experience. It lets me know that no one is alone in their experiences. It was very scary and bewildering. And the fact that the medical staff seemed completely unperplexed about it was almost as bewildering. The staff that day was not the staff that saw her the day before, walking the halls with me and my sister, chatting about the photographs on the wall, completely lucid and “normal.” At that point, she should have been discharged. But, another learning, if she had been—at fewer than three nights—Medicare would not have paid. We have the most stupid-ass system.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s