Dealing with delirium in the hospital setting
Last month I was asked by OLLI (Osher Livelong Learning Institute) to present at a brown bag lunch about delirium in the hospital setting. I needed an expert to cover the medical stuff and invited Tim Haskett, FNP with the PACE program at the Humboldt Senior Resource Center and a very talented geriatrician to help. I covered the social-worky stuff and we both gave lots of advocacy tips.
Every attendee had an emergency room, hospital inpatient setting, or post-operative recovery story and many of them had witnessed delirium in a family member or experienced it themselves.
Delirium is a sudden change in mental status that can be cause by a number of factors and often occurs when older adults are in the hospital or after they have surgery. Acute illness, surgery and medications all can contribute to its onset, as can a disruption to one’s regular routine. Common signs include confusion, mood swings, memory loss, decreased attention or concentration, insomnia or changes in sleep patterns, or hallucinations, among other things.
Here are some tips for your next hospital stay or surgery to help minimize the chances and impact of delirium.
1. Never go alone. When you are sick is no time to go to a hospital by yourself. You aren’t thinking straight or listening right. If you are really sick, you aren’t even talking right. Those of us who live alone or live with others who aren’t around us 24/7 need to have something in our wallet and on our fridge for the emergency personnel indicating who to call in case we can’t speak for ourselves.
2. This “something” is an advanced directive which designates someone to make medical decisions on your behalf when you are unable to do so. Make sure you doctor and agent both have copies. Make sure it or an indication of it is on your fridge and in your wallet. In an emergency, this will really matter.
3. Bring a current list of both your medication and your health problems. This needs to be written down in advance, regularly updated, and put with your advanced directive and in your wallet.
4. Have an advocate. This could be your agent in the Advanced Directive, but also others who agree to be in your hospital room during your recovery and tell the hospital staff what they need to know about you when you can’t.
Your advocate’s duties are to:
*Stay with you. Ideally you will have lots of visitors – not the kind that you need to entertain, but those who will sit with a book and be there if you need something and know you well enough to see you in a hospital gown. Make sure that person isn’t afraid to ask for help, but won’t scream at the staff, which is never helpful.
*Ask questions. About what procedures they are performing, when you will be discharged, when you can get up and walk around, etc.
*Share information with staff about you and watch for changes in your behavior. Staff don’t know you like your friends and family do. This is usually a good thing, but in medical care, they need to know if what they are seeing is your normal or something else.
*Write things down. There is a lot of information and no one will remember it all without taking notes.
*Make sure you have glasses, hearing aids, and dentures so you can use all your senses to understand what is happening around you.
*Encourage you to engage in physical activity, games and conversation. This provides your body and brain with the stimulation needed to get well again.
*Bring familiar things from home. Anything that fosters your regular routine, will keep your brain stimulated and in touch with reality.
For more information on preventing and managing delirium, check out www.healthaging.org
**Image from https://medlineplus.gov/magazi...