How long does delirium last in the elderly?

Delirium is an issue that often goes unnoticed or misunderstood in the elderly - and if you're wondering how long delirium can last in older individuals, you're not alone.

Understanding this condition is crucial for the well-being of our elderly loved ones, so we’ll be using this blog to explore its causes, symptoms, duration, and most importantly, how to manage delirium in the elderly effectively.

What is Delirium?

Delirium is a medical condition characterised by sudden confusion, changes in alertness, and disturbances in cognitive function. It can manifest rapidly, often within hours or days, and requires prompt attention. Delirium is not a disease itself but rather a symptom of an underlying medical issue. It can occur in people of any age but is more common and often more severe in elderly individuals.

Causes of Delirium in the Elderly

Delirium in the elderly can arise from a number of factors, each contributing to its onset and severity. From infections to underlying health conditions, having an understanding of these triggers is important for effective management and prevention of delirium episodes. Some of the triggers include:

Infections

Infections, especially in the urinary tract and respiratory system, are notorious culprits for triggering delirium in elderly individuals. Urinary tract infections (UTIs), in particular, are common among the elderly and can often go undetected. The infection's inflammatory response can lead to changes in brain function, causing confusion and disorientation, hallmark symptoms of delirium.

Similarly, pneumonia, a lung infection, can also provoke delirium due to the body's systemic response to the infection, affecting the brain's neurotransmitter balance.

Medication Side Effects

The medications prescribed to manage various health conditions can sometimes contribute to delirium in the elderly.

Certain medications, especially those with sedative effects, pose a significant risk. Drugs such as benzodiazepines, often used to manage anxiety or insomnia, can depress the central nervous system, leading to confusion and cognitive impairment. Similarly, anticholinergic medications, commonly used for conditions like overactive bladder or allergies, can disrupt neurotransmitter function, exacerbating delirium symptoms.

Dehydration or Malnutrition

The importance of adequate hydration and nutrition cannot be overstated, especially concerning the elderly population's cognitive health. Dehydration and malnutrition can profoundly impact brain function, making individuals more susceptible to delirium. Dehydration can disrupt the body's electrolyte balance, affecting nerve transmission and cognitive processes.

Likewise, malnutrition deprives the brain of essential nutrients, impairing its ability to function optimally. Ensuring proper hydration and nutrition is, therefore, paramount in reducing the risk of delirium in older adults.

Underlying Health Conditions

Chronic health conditions such as dementia, Parkinson's disease, or stroke can serve as fertile ground for the development of delirium in the elderly. These conditions alter the brain's structure and function, rendering it more vulnerable to external stressors.

Elderly individuals with dementia, for example, have underlying cognitive impairments that can be exacerbated by factors such as infection or medication changes, precipitating delirium. Similarly, Parkinson's disease can affect neurotransmitter levels, making individuals more susceptible to delirium triggers.

Surgery or Hospitalisation

While hospitals are designed for recovery, they can also be breeding grounds for delirium, especially in elderly patients. The stress of undergoing surgery or being hospitalised can disrupt normal sleep-wake cycles, increase anxiety levels, and expose individuals to unfamiliar environments and routines - all of which can precipitate delirium. Additionally, the use of anaesthesia and pain medications during surgery can further exacerbate cognitive impairment, prolonging the duration of delirium post-operatively.

Symptoms of Delirium in the Elderly

Identifying delirium in the elderly can be challenging as its symptoms can vary widely and may overlap with other conditions. Common signs of delirium include:

Fluctuating Alertness

One of the hallmark symptoms of delirium in the elderly is the fluctuation in alertness levels. This can manifest as periods of hyperactivity followed by sudden bouts of lethargy or drowsiness.

During episodes of heightened alertness, individuals may appear restless, talkative, and easily distracted. However, these periods are often short-lived and give way to moments of confusion or disorientation, where they struggle to maintain focus or engage in coherent conversation. Recognising these fluctuations in alertness is crucial for identifying delirium and initiating appropriate interventions promptly.

Confusion

Confusion is a hallmark feature of delirium, presenting as disorientation, cognitive impairment, and memory deficits. Elderly adults experiencing delirium may find themselves lost in a fog of uncertainty, unable to grasp their surroundings or make sense of their experiences. Simple tasks such as following conversations or recalling recent events become challenging, leading to frustration and anxiety.

Loved ones and caregivers may notice subtle changes in behaviour, such as repetitive questioning or difficulty concentrating, indicating the presence of confusion - a red flag for underlying delirium.

Hallucinations or Delusions

Delirium can play tricks on the mind, leading to the emergence of hallucinations or delusions in affected individuals. Hallucinations involve perceiving sensory experiences that aren't based in reality, such as seeing or hearing things that aren't there. Delusions, on the other hand, are irrational beliefs or thoughts that persist despite evidence to the contrary. These hallucinations and delusions can be extremely distressing for both the elderly individual experiencing them as well as their caregivers.

Agitation or Restlessness

Agitation and restlessness are common indicators of delirium in the elderly. Individuals may exhibit pacing, fidgeting, or restlessness, unable to settle or relax. They may express irritability or frustration, reacting impulsively to stimuli in their environment.

In some cases, agitation can escalate to aggressive behaviour, posing risks to both the individual and those around them. Recognising these signs of agitation is crucial for implementing strategies to manage behavioural disturbances and ensure the safety and well-being of all involved.

Sleep Disturbances

Delirium can significantly impact sleep patterns, leading to disturbances such as insomnia or excessive daytime drowsiness. Individuals may struggle to fall or stay asleep, experiencing fragmented and restless nights. Alternatively, they may find themselves overcome by overwhelming drowsiness during the day, making it difficult to stay awake and alert. These sleep disturbances further exacerbate the cognitive and behavioural symptoms of delirium, creating a vicious cycle of impairment and dysfunction.

How long does delirium last in the elderly?

The duration of delirium can vary depending on its underlying cause, promptness of treatment, and individual factors. In some cases, delirium may resolve within a few days once the underlying issue is addressed. However, in others, it can persist for weeks or even months, particularly if there are complicating factors such as chronic illness or cognitive impairment.

Prompt medical attention is key to managing delirium effectively. By identifying and addressing the root cause, healthcare professionals can help shorten the duration of delirium episodes. So, if you notice signs of delirium in yourself or someone you care about, don't wait around - getting help fast is key to getting back to normal.

Now, let’s look into some of the strategies used for effectively managing delirium in the elderly.

Managing Delirium in the Elderly

Managing delirium in an elderly individual involves addressing the underlying cause while providing supportive care to ease symptoms. This may include:

Medical Evaluation

A comprehensive medical evaluation is the cornerstone of managing delirium in the elderly. This process involves a thorough assessment by healthcare professionals to identify and treat any underlying medical conditions or infections contributing to the onset of delirium. From urinary tract infections to pneumonia, identifying and addressing these underlying triggers is essential for effective management and resolution.

Medication Review

Reviewing and adjusting medications play a key role in mitigating the risk of delirium in older adults. Healthcare providers can evaluate the medication regimen, aiming to minimise potential side effects and interactions that could exacerbate delirium symptoms. This may involve tapering or discontinuing medications known to increase the risk of cognitive impairment, such as benzodiazepines or anticholinergic drugs.

Hydration and Nutrition

Ensuring adequate hydration and nutrition is vital in supporting brain function and overall well-being in elderly adults with delirium. Dehydration and malnutrition can exacerbate cognitive impairment and prolong the duration of delirium symptoms. Healthcare providers prioritise interventions aimed at replenishing fluids and nutrients, whether through oral hydration strategies or intravenous supplementation.

Environmental Support

Symptoms of delirium in the elderly can be eased by creating a therapeutic environment. This typically involves designing a calm, familiar setting with minimal stimuli to reduce confusion and agitation. Healthcare facilities and caregivers strive to create comforting surroundings, minimising noise, bright lights, and other potential triggers for delirium.

Family and Caregiver Involvement

Loved ones provide invaluable support, offering emotional reassurance and practical assistance in monitoring changes and providing companionship during episodes of delirium. Healthcare teams may collaborate closely with family members and caregivers, empowering them to play an active role in the care process. By building a robust support network, individuals with delirium receive comprehensive care that addresses their physical, emotional, and social needs.

Introducing YourStride Alarm Watch

In addition to proactive management strategies, having access to immediate help can provide invaluable peace of mind for older adults experiencing delirium or other medical emergencies. That's where the YourStride Alarm Watch steps in. With its automatic fall detection and 24/7 emergency support, the YourStride watch offers true security and peace of mind for the elderly and their loved ones.

Whether at home, in the garden, or out and about, the YourStride ensures protection around the clock. Simply press the SOS button on the watch to request emergency support, or let the watch automatically detect a fall and initiate assistance. With the ability to speak directly through the watch to a dedicated 24/7 monitoring team, help is always just a button press away.

For more information on the YourStride alarm watch, click here.

Disclaimer: The information provided in this blog post is for informational purposes only and should not be considered a substitute for professional medical advice.