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.