Dementia Dissections: Delirium Versus Dementia

Hospital delirium is a sudden change in attention & awareness (worse-than-usual mental function) that waxes & wanes in their ability to focus on a task, unawareness in knowing common things (where you are, what time it is) which can affect their perceptions & reasoning.

The signs of delirium are difficulty paying attention, seeing or hearing things that are not really there, restless/angry or tense behavior, unsure of people and where they are, confusing speech that is hard to understand, sleep a lot or too little with possible days and nights mixed up, and behavior changes that come and go during the day.

Hospital Delirium can happen to anybody and can take many forms. This is a common and very important problem for ALL OLDER ADULTS in the hospital. Risks include: age 65 years and older; cognitive impairment (past or present) and/or dementia; current hip fracture; and severe illness (deteriorating or at risk of deterioration). Delirium can be hyper- or hypo-active.

Having had delirium before is a strong risk factor for future delirium.

Diagnosing delirium is extremely important. You know your person best. ADVOCATE and COMMUNICATE with hospital staff.

Your person’s safety is important. Delirium can look like dementia such as difficulty with memory, but unlike dementia, most people will improve as their medical condition improves.

Why does delirium happen? It is often a direct consequence of a medical illness, a medication or toxin, substance use or substance withdrawal and can have multiple causes, such as: Urinary Tract Infection (UTI) which is a frequent cause in older patients; stroke; sedation for procedures; medications like benzodiazepines (lorazepam, alprazolam, diazepam) taken for anxiety, muscle spasms and seizures; electrolyte imbalances; lack of oxygen or low blood sugar. Hospital delirium is the most common surgical complication among older adults. In the ICU, it is sometimes referred to as “ICU psychosis”. There is a higher incidence of hospital delirium in those requiring mechanical ventilation.

40% of all hospital delirium is preventable! How?

Sleep which is difficult in the hospital – impossible in the ICU. Try bright room during the day, dark at night when possible; earplugs, eye masks; melatonin if used at home; ask to avoid middle-of-night checks when possible.
Move as much as possible to reduce the risk of delirium.
Bring hearing aids with fresh batteries, glasses, dentures to engage in their environment.
Involve and empower your person with: frequent family visits as families play a key role in lessening delirium effects. Family can reorient the person, reminding them of where they are, why they are in the hospital; watch for delirium, alert medical staff, bring family pictures, favorite blanket, music. Turn off the TV when not actively watching. Avoid in-room talking with patient who is not actively involved – go to the hallway to talk. Keep conversations simple, talking about one topic at a time; stay with patient as much as possible; try to arrange family to take turns staying with patient around the clock.
Treat pain!
Hydrate – assess for dehydration & constipation
Address poor nutrition
Avoid physical restraints or urinary catheters (if possible).
Be patient & compassionate – provide reassurance & support

Their words may not align with the person you know. They might become angry with you or forget who you are. It is not your fault. Try to remain calm. It is typical to feel fear, frustration, embarrassment, sadness, or guilt in this situation. Ask to speak to a hospital social worker, chaplain, faith community nurse, or counselor if you are struggling.

References:

https://www.healthline.com/health/hospital-delirium. Sept 29, 2022

HealthEast: Delirium in the Hospital: Understanding & Caring. Dev. 3/13 Rev. 6/13

https://www.bottomlineinc.com/health/aging/what-you-should-know-about-hospital-delirium/ May 7, 2025. Amanda Pomerantz, DO, assistant professor of psychiatry at U of alabama Brimingham.

https://betterhealthwhileaging.net/hospital-delirium-what-to-do/ Leslie Kernisan, MD, MPH. 2014, updated March 2024

https://www.ncbi.nlm.nih.gov/books/NBK553009/ 2023 Jan 18

https://www.healthline.com/health/hospital-delirium. Sept 29, 2022

https://www.medicalnewstoday.com/articles/hospital-delirium. Last reviewed 2019

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