Delirium can happen to those who suffer from dementia, but it can also indicate other medical issues.

My mom has mild memory problems and got the flu. We ended up at the emergency room, really sick and they called her delirious.

Scared

The word “delirious” gets thrown around in casual language, but has a different meaning when in the medical sphere. Delirium usually happens to people as a result of an imbalance due to a chronic illness, metabolic imbalance, medication issues, surgery, or withdrawal from alcohol. Infection can cause it as well.

This topic is especially relevant as flu season is starting. Talk to your doctor about the flu shot.

Symptoms of delirium include disorganized thinking, memory problems, restlessness, change in energy, concentration and being withdrawn; or the person may be rambling and have delusions.

The medical literature talks about two kinds of delirium: one called “hypoactive” and one called “hyperactive.”

Hypoactive delirium is more common with elderly people. They may happen with a person being slow, inactive, being sleepy or withdrawn. It can happen with younger people, too.

The hyperactive delirium is easier to recognize. You see the individual afraid, restless, repeating movements and having hallucinations and delusions. To complicate things further, a person may have symptoms of both simultaneously.

Delirium is not the same as dementia or depression, although it can happen to people who have those illnesses, making it harder to figure out what’s occurring.

The signs and symptoms of a delirium mimic dementia symptoms, so your role (as a family member) is critical in explaining the individual’s baseline function.

In fact, having dementia, Parkinson’s disease or suffering a stroke can predispose you to delirium, as can being elderly, or having had an incident of delirium in the past. Delirium may have one or multiple causes.

It can have a particularly negative impact on a vulnerable brain, impairing the brain’s ability to receive or send out signals.

Some common triggers for delirium include fever, acute infection (like a flu), urinary tract infection, a toxin, sleep deprivation, or anesthesia. Certain drugs for asthma, Parkinson’s, pain and low oxygen can also be culprits.

Seeing a loved one in this state often distresses families, as the person is “not themselves.” They may say or do things that are upsetting.

First and foremost, good medical treatment is essential to managing the issue and the health team will ensure they identify and treat the cause.

Delirium can last from hours to days or even months, and the recovery period is partially dependent on the state the person was in prior to the onset.

Some individuals regain normal function while others may experience long-term impact if they were already compromised prior to their diagnosis of delirium.

Dr. Sid Feldman, head of family medicine at Baycrest Health Sciences explains: “As a caregiver, your job is to help maintain calm, keep things organized and orient your client or loved one. Keep things simple and as stable as possible. Familiar faces are very important but don’t overdo the number of visitors.

“Try to ensure your loved or relative one drinks and eats well. Ensuring they wear any required assistive hearing device and/or glasses is important to create an easier environment. Familiar objects such as blankets and family photos may also help. Rest and quiet are equally important.”

If you are the first person to notice a change, seeking medical attention early is a good idea. Help the nurse or doctor understand what you are witnessing. How long has it been going on? Is there new medication or a sudden change in function? Has there been a recent infection or cold?

Once the treatment starts, its focus is to create the ideal environment to calm the brain and heal the body. Take care of yourself too, as it’s scary and both mentally and physically challenging to look after someone experiencing delirium. Hopefully, their symptoms will settle or be reduced with treatment.

Nira Rittenberg is an occupational therapist who specializes in geriatrics and dementia care at Baycrest Health Sciences Centre and in private practice. She is co-author of Dementia: A Caregiver’s Guide, available at www.baycrest.org/dacg Email questions to caregivingwithnira@baycrest.org

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