When older adults are hospitalized, they can become confused and disoriented.
This is often due to a temporary delirium, which is different than the more persistent symptoms we see in dementia, such as Alzheimer's disease.
A diagnosis of delirium is based on four factors: sudden onset of symptoms that fluctuate in severity; inattention; disorganized thinking and an altered level of consciousness. Generally, delirium clears within a few days, but may persist for several weeks or months.
A recent study places the incidence of delirium in post-operative hip-replacement patients at 11.6 percent. Other studies estimate incidence rates as high as 33 percent.
Delirium is independently associated with increased length of hospital stay, serious illness and death, long-term cognitive and functional deterioration and higher rates of institutionalization. Delirium constitutes an economic burden to the health care system estimated at $60,000 per patient per year.
Risk factors for delirium include being 65 or older, having a prior or current cognitive impairment, current hip fracture and/or another severe illness. Medications, metabolic disorders, infection, surgical procedures and neurological disorders also increase the risk.
A program designed to help prevent or properly treat delirium among hospitalized patients has shown to be effective. Central Baptist Hospital plans to begin the Hospital Elder Life Program (HELP), developed by Dr. Sharon Inouye of Yale University, by January. As part of HELP, select patients are screened for delirium risk factors. If present, a prevention program is prescribed for each patient. Many program interventions are designed to be performed by non-medical volunteers or family members.
The program's components include a sleep-enhancement protocol of back rubs and herbal tea; getting the patient up and walking early and often; insuring patients have access to clean and working visual and/or hearing aids; therapeutic activities such as knitting or reading; and a plan to ensure adequate fluid intake.
Though the interventions are simple, HELP has been shown to be surprisingly effective. The New England Journal of Medicine reported a 34 percent reduction in delirium patients using the program.