Delirium

Something I have had a gift at acquiring lately… Patients with delirium.

Okay, I am an oncology resident.  And many of the patients we wind up admitting onto the Rad Onc service are those who are elderly and with multiple medical conditions, two things that predispose you to a delirium at baseline, then you add admission to hospital and one other little thing happens and poof… Delirium.

In fact, I have been so stuck with delirium, I did a presentation at rounds about it.

Delirium, for those of you who may be wondering what the blankety blank I am rambling on about, is a condition in which patients develop acute onset of fluctuating changes in their mental status accompanied by all kinds of sequelae that is due to an underlying medical condition.  People who are older are more at risk for this.

There are a ton of theories as to the cause of delirium, mainly involving changes in neurotransmitter caused by various chemicals due to disease and the body’s response to disease.

The biggest thing is that delirium sucks.  Very profound.

Delirium increases the odds of death in age and disease matched people.  It increases the length of stay in hospital and risk for complications.  It increases the risk of cognitive impairment in the future.  People who stay delirious for a long time can have significant deficits.

People who are delirious are confused and can be very drowsy or agitated.  Some of them have hallucinations or paranoid ideations and all kinds of other miserable things.

It is sad to see someone who is very delirious.  Especially if you know them at baseline.

The people who are agitated and paranoid are the most distressing to me.  If you are drowsy and such, it is sad, but people who are agitated and paranoid and hallucinating are so terrified and endanger themselves in all sorts of ways.  Non-ambulatory old ladies trying to leap out of chairs to “defend herself.”  People refusing medications because they are poisoned.  Hearing screaming children and seeing animals in the corners.  That is scary stuff.

From the outside, it is easy to try to redirect them or say things aren’t real.  But, for that patient, it is real.  So real.

I can’t imagine what I would do if I heard screaming children and thought people were out to get me.  I would freak out too.  Especially when they respond by telling me it all is not real and pin me down with a tranquilizer.

There is a good chunk of research into delirium.  We now know restraints make it worse.  That it is good to redirect, but not argue with these people.  We know that the best treatment is to fix the underlying problem (though, sometimes it isn’t easy to find).

But still, so many people become delirious.  And the fear in their eyes when you really look at them can be heart breaking.

Not everyone is so bad off.  Some people are “pleasantly confused.”  Better than being paranoid.  Still, it is hard for the family to see.

Patrick’s grandmother was delirious and it was miserable for everyone involved.  She recovered from the delirium, thank goodness.  But not after arguing about the lion in the corner and seeing all kinds of weird stains on our clothes.

I wish there was something sunny I could say other than most people recover.  But, really there isn’t… Aside from the fact that people say funny things sometimes… Like looking for a mailbox to mail their underwear…. Naked except a towel… In a hallway.  Not funny at the time, but entertaining in retrospect (to the person included).  Or the time my grandmother powerwalked away from her special care home and made it to the town border before people caught up with her.

At least we can treat it, for the most part.  And provide comfort the best way we can.

On a lighter note… An MGMT song with Delirium in the title.

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5 thoughts on “Delirium

  1. My mother was in and out of it during her last three months and it was easier to work with her. She saw people come out of the TV so we turned it around. I had to get the hordes of folks (no one was there) out of the bathroom before she would go. It was just easier to humor her and keep her happy.

    • So true… Humoring people can be easier, so long as thy aren’t hurting themselves. I tried to get the stains out for Patrick’s grandmother and promised to put things in the laundry as soon as we were home and life was much easier.

  2. My grandmother always developed “sundowners” when she was in the hospital. She would be totally in another place mentally, and snap right out of it once she was released from the hospital. Happened every single time for about 10 years. She was remarkably clear headed until she died at 96–clear headed except for during her hospitalizations, that is!

  3. Pingback: Hospital delirium: not as negligible as previously thought « Health and Medical News and Resources

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