Delirium is real and a huge risk for aging patients

Originally published at:


I think we’re all aware of delirium’s growing importance in our daily lives.


yeah, I think we all came here for the Biden references (and the bbs fates agree…):


At the administrative/quality improvement level in hospitals there has been work for quite some time wrt reducing these risk factors, at least in my country. It comes with a fairly robust economical argument too - delirium worsens outcome and hospital stay.
An issue is though that many of the things that are done to reduce delirium have a relatively small effect size, especially when people are already delirious. And a lot of your older patients will be arriving delirious, with risk factors that cannot be modified in the short tern. The modifications are worth doing absolutely. You just need to predict that plenty of your patients are going to be delirious even with best practice. Delirium is related to both risk factors like age/polypharmacy/pre-existing cognitive impairment - and severity of illness. And your sickest people obviously should be in hospital.

Plus there aren’t always sufficient measures in place to ensure that people who are delirious us are picked up on busy medical wards. It doesn’t always present in the florid agitated state. It can present subtly, or with a hypoactive state that looks like fatigue or depression. And it’s almost by definition fluctuant - someone can seem fine but if you check the nursing notes “oh okay they were NOT okay two hours ago”.

I don’t have the answers. But ensuring that as well as preventing delirium, it is picked up when it occurs, there is education to families about what it might mean, and there is adequate after care for individuals that do suffer it is an area is like to see more attention. Unfortunately with more and more bed pressure, pressure on social services, that kind of holistic care will only get harder.


And collective delirium?

I’m starting to wonder if we’re on the verge of that.


My Father at aged 89 got admitted into hospital and by all accounts he was being a bit of a pain in the ass to the nurses. Their solution was to put him on anti psychotics which turned in into a incoherent mess. When he came out after consulting with his doctor I ditched those drugs and after 5 days he was just coming back to us when he fell out a window in the night and died.
That my dad was being a nuisance was not really like him and I suspect delirium was to blame.


How to tell if someone has delirium:
If they keep saying “Man, I shouldn’t have dropped that acid . . .”

Wow, that must have been awful. My dad had advanced Parkinson’s and some other syndromes and just decided not to wake up one morning. My 4 day bedside vigil until he passed his last breath seems a mercy compared to your situation.

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