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The Lowdown on Delirium

Kaiser Permanente Northern California is getting the word out about the condition that afflicts some hospital patients.

Frightening hallucinations, paranoia, agitation, confusion, and disorientation are all signs of a little-known condition called delirium that afflicts 7 million hospital patients each year nationwide.

World Delirium Awareness Day was March 13, and The Kaiser Permanente Delirium Prevention and Management Program used the occasion to boost awareness of this potentially dangerous condition.

Kristen Brooks, MD

We sat down with Kristen Brooks, MD, a physician at the Kaiser Permanente San Rafael Medical Center who is an expert on delirium and a team member of the delirium management program, for a primer on what it is and how families and hospitalists can prevent and treat it.

What is delirium?

Delirium is an abrupt and acute but usually temporary state of confusion that comes on as a result of a medical problem. It can range in severity from fogginess, disorientation, and agitation to incredibly distressing hallucinations and paranoia. I’ve had patients who thought we had kidnapped them and tried to kill them. I had another who thought she could hear children crying in the next room and was worried. It runs the gamut. But delirium is not dementia. Dementia is a chronic, progressive decline in cognitive function while delirium is abrupt, and it waxes and wanes.

What are the causes and risk factors of delirium?

There are a lot of theories about the causes, but we don’t totally understand it. If you give someone an opiate pain medication, they can get delirious, or if they have an infection, they may get delirious. Low oxygen levels can cause it, as can severe illness, drug or alcohol withdrawal, surgery, dehydration, pain, and organ dysfunction.

Who gets delirium?

It affects 1 in 5 hospital patients, with 50 percent of those over age 75.

What are the dangers?

Patients with delirium are more likely to be admitted to a skilled nursing facility, are more likely to have long-term cognitive problems, and are more likely to die even after the hospitalization. It can also increase the risk for falls and injuries in the hospital.

How is delirium prevented and treated?

We know that 30 to 40 percent of cases can be prevented. If we see it, we try to stop all medications that may be contributing to it. Then there are a variety of behavioral interventions, including making sure the patients sleep well at night, keeping them awake and active during the day, making sure they have regular bowel movements, and making sure they stay active and engaged in their care. Lastly, if all the behavioral interventions don’t work, and they are so agitated there is a safety issue, we may use anti-psychotic medications.

We try to educate families if a patient is at risk. We ask families to help our team understand the patient’s baseline cognitive functions and ask them to let the care team know if they start to see confusion.

If a patient is delirious, what can family or friends do?

If the patient is hospitalized, avoid too much noise and too many visitors or loud television, use a soothing voice when talking with the patient, keep calm and limit distractions, and bring some familiar objects from home to help keep the patient calm.

Finally, is there any good news?

At the San Rafael Medical Center we were able to reduce the length of stay for delirious patients by almost 2 days. Our regional team took that program and expanded, tested, and improved it and now we are taking a hands on, proactive approach to delirium prevention and management in all 21 of our regional medical centers.