Don't Let Confusion Take Over

Delirium often undiagnosed but preventable and treatable

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) It may seem normal for elderly people to become confused or forgetful, but this is not usually just "normal aging." Severe confusion can be an indication of delirium.

Delirium is different from dementia, but it is often misunderstood or undiagnosed. It often occurs in the hospital when a person becomes extremely confused or disoriented.

A recent extensive review of the research on delirium reveals that it can lead to negative long-term effects, but it is treatable and preventable.

"Be aware of any personality changes in loved ones."

The study, led by Babar Khan, MD, MS, assistant professor of medicine at the Indiana University School of Medicine and a researchers at the Indiana University Center for Aging Research, reviewed the research on delirium in four major research databases.

These databases included Medline, PubMed, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature (CINAHL).

They pulled all the studies that were systematic reviews of the evidence on delirium and were published between January 1966 and April 2011.

Additionally, three of the researchers looked specifically at the data as it related to risk factors for delirium, outcomes for delirium and preventing, diagnosing and treating delirium. They rated the review studies as good, fair or poor.

Among the 585 studies they looked at, 22 were rated as fair or good based on their data.

Together, the studies revealed that the risk of delirium is increased by a number of factors.

The older a person is, the more likely they are to experience delirium. Those who have cognitive impairment or depression are also more likely to experience delirium.

The risk for delirium also increases if a person uses anti-cholinergic drugs or the anti-anxiety drug lorazepam (Ativan).

Anti-cholinergic drugs are ones that act on nerve fibers, most commonly to relieve allergies or treat other breathing-related conditions, such as chronic obstructive pulmonary disease (COPD).

The researchers found that several non-drug interventions can help reduce delirium in elderly patients.

In addition, a low dose of the drug haloperidol (Haldol) and a class of drugs called "atypical antipsychotics" can be used to treat delirium.

Overall, delirium is linked to poor long-term effects, regardless of a person's age, how bad their illness is or whether they have dementia.

In other words, people who experience delirium are less likely to recover as well from their illness or surgery.

Delirium increases the risk that someone will develop dementia, and it triples the risk of death.

An estimated 60 percent of the 7 million Americans who experience delirium in the hospital each year are not properly diagnosed or treated, according to the American Delirium Society.

Yet, the researchers also found that delirium could have been prevented in one third of the cases discussed in the studies they reviewed.

“We need to develop better mechanisms for diagnosing delirium so that prompt treatment regimes can be initiated,” said co-author Chris Fox, MD. "Hospital staff commonly label the signs as dementia related and do not pick up the delirium.”

Some of the things that can be done to reduce the risk of delirium including treating a patient's depression and removing restraints from a person.

Hospital staffs can also make sure patients have access to their glasses and/or hearing aids and can prescribe the medications (antipsychotics) that can help without otherwise negatively affecting the brain.

The study was published in the September issue of the Journal of Hospital Medicine. The research was funded by the National Institute on Aging and the National Institute of Mental Health.

Reviewed by: 
Review Date: 
September 24, 2012
Last Updated:
September 25, 2012