My Father Has Delirium
My father is in the hospital and they say that he has delirium. What exactly is delirium?
Delirium is a state of severe confusion that is usually brought on by a medical condition. It’s thought to be due to the brain producing too much dopamine and to little acetylcholine. Dopamine and acetylcholine are neurotransmitters (chemicals) that neurons (the main cells of the brain) use to communicate with each other. Nobody knows why being sick causes these chemicals to get out of balance. However, when they get out of balance people experience a typical set of symptoms called delirium.
So what exactly are the symptoms of delirium?
The first symptom of delirium is a disturbance of consciousness (awareness) that keeps you from being able to focus (concentrate or pay attention). The second symptom involves a change in your thinking. Either you can’t remember things, you’re confused about where you’re at, you start hallucinating, or a combination of these. People often describe this set of symptoms as “he was talking out of his head”. The third thing to remember about delirium is its time course. Delirium happens over a relatively short period of time (hours to days and not months to years like what happens in the dementia).
Okay, that sounds like what’s happening to my dad. Now what are we going to do about it?
When someone gets delirium, there’s two main things that need to be done. The first, is figuring out what caused the delirium so that it can fixed. (This is best left up to the doctors). The second thing to do is treat the symptoms.
So how exactly are you going to treat the symptoms of delirium?
Treating delirium consists of two main treatments. First, medications, (called antipsychotics) can be used to decrease the abnormally high amount of dopamine in the brain. The second “treatment” is not actually a medication but more a set of behaviors that can help make delirium resolve quicker. The national Institute for Clinical Excellence (NICE) in the United Kingdom has published a set of guidelines consisting of several behaviors we can do to help prevent delirium. Although it has not been proven to actually treat delirium once someone has it, we think that instituting these behaviors can help delirium resolve faster, or at least keep it from returning once it has resolved. Some of these behaviors need to be implemented by the healthcare team. However, many of these behaviors are simple and can be instituted by the patient’s family.
OK, I’m on board, what can I do to help.
One of the main problems with delirium that can be addressed by family members is re-orientation. That simply means reminding the patient where they’re at, what time it is, and why they’re in the hospital. Remember, people with delirium have very poor memories and sometimes need to be reminded 20, 30, 40, even 50 times in a single day. Another intervention that can be better initiated by the family than anyone else is making sure that the patient has their hearing aids, glasses, dentures, and other devices from home. Without these, patients do much worse. Other things families can do include making sure that the hospital has a list of the patient’s medications as well as helping the patient eat and move around. Patients with delirium often have trouble communicating with their healthcare providers. Therefore, the family can help tell the healthcare team if something is wrong with the patient. Some of the conditions to watch out for and let the team know about are dehydration, constipation, trouble breathing, signs of infection, trouble walking, and pain. The last, and perhaps the most important, thing to remember about the delirium is that it gets much, much, much, worse when patients don’t sleep normally at night. Therefore, things that we can do to help patients sleep better at night include leaving the blinds open through the day, keeping the patients active and busy through the day, as well as being quiet and leaving the lights off at night.
No Comments