In caring for the elder population, I see many patients with forms of dementia. Often, they are admitted
to the hospital generally because of negative behavior that is atypical and often frightening to the
family, or for evaluation to determine the cause of a troubling change in thinking. One disorder quite
prevalent in the hospital in elders is delirium. Unlike dementia, which is an often subtle decline in
thinking and ability over time, this decline in orientation, judgment, thinking, and level of consciousness
is quite sudden. It is common in elders with dementia.
The causes of delirium are many; infection, severe illness, dehydration, metabolic imbalance (too little
sodium or potassium for instance), fractures, medication, anesthesia and visual impairment. Any sudden
change for the person with dementia can bring on delirium; hospitalization is a main cause. The elder
feels confused, becomes agitated, disoriented, often hallucinates and is combative. This is their way of
fighting their way out of a confusing environment. The emergency room and intensive care unit are
places that bring on delirium in elders due to the isolation (curtains around the bed) and strange
unidentifiable noises (monitors, overhead pages, ventilators). Isolation due to COVID can also bring on
delirium.
It is important to know the difference between the progression of the chronic illness causing dementia
such as Alzheimer’s disease, and onset of delirium. A good rule of thumb is if sudden changes in thinking
occur in an elder, with or without dementia, it is usually a medical problem. It is important to get
medical evaluation right away. Delirium is treated according to the cause; antibiotics for infection, IV
fluids for dehydration, and so forth. During the period of delirium, however, the best thing a family can
do is be present to comfort and reassure through the hospital treatment. The familiar person from
home can keep the elder safe and help him or her through this frightening experience best. Again, the
presence of the caregiver is crucial to the elder with dementia and delirium find comfort.