Recognizing the Frightening Behaviors of Delirium

How many of you at one point or another in your youth found a way into your parent’s liquor cabinet or bribed someone just a little older to purchase alcohol for you and then drank until you were overly intoxicated?  How many of you know people who occasionally partake a little too much?  Their personalities change with alcohol intoxication.  Their speech rambles, they appear mentally or physically disoriented, they become agitated or confused, angry or mean, they imagine things that aren’t real or recall events that haven’t occurred.

Older adults exhibit similar behavior but not generally because they have consumed large amounts of alcohol.  The behavior is called delirium.  If you have never been in the presence of a delirious older adult you may not recognize what is happening or the importance of responding quickly.

A recent incident in which I was involved had the staff at an assisted living community call me to tell me my client was dying because she was seeing and talking to her son, who had died years ago.  She commented that she wanted to be with him.  The day prior, there was nothing wrong with my client.  There was no recent illness or a terminal diagnosis.  This day she was acting out of character.  She was disoriented and delusional and appeared physically unwell.  To someone not knowing my client, she might have appeared to be actively dying.  I suspected this was not the case and ordered a call to 911.

In the emergency room, my client was diagnosed with a urinary tract infection and pneumonia.  Delirium is the result of acute illness or infection, surgery, medications or a long list of other exterior causes or physical changes.  Delirium should be investigated immediately to determine the cause and the related factors should be treated.  If delirium is ignored, serious health declines and even death may be experienced.

According to research by the Australian Health Department1 certain older people appear to be at greater risk of developing delirium.  These include:

• Those with dementia

• Age greater than 70 years

• Diagnosed with depression

• Those with visual or auditory impairment

• Persons taking three or more medications

• Those with an indwelling catheter

• Persons living in residential care communities

If you are a family caregiver, it is important to be aware and to act immediately if your loved one or the person for whom you provide care experiences a sudden onset of behavioral changes.  They may be experiencing delirium.  A quick response is critical to avoid unintended and serious consequences.

Reference:  1)  www.health.gov.au – Delirium Assessment

© 2012, 2013 Pamela D. Wilson, All Rights Reserved.

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