Tag Archives: delirium

Delirium Screening in Skilled Nursing Facilities

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Journal of the American Geriatrics Society Research Summary

Delirium and Alzheimer’s disease and related dementias (ADRD) can play a role in the mental decline of older adults who enter skilled nursing facilities (SNFs) for rehabilitation after being hospitalized. Healthcare practitioners may mistake these conditions for each other or even overlook them, even though they are distinct conditions and require different treatments.

Delirium is a term that means “sudden confusion. ” It is an abrupt, rapid change in mental function that goes well beyond the typical forgetfulness of aging. Delirium is a result of abnormal functioning of the brain and requires the attention of a healthcare professional.

On the other hand, ADRD is a progressive and chronic decline in your cognitive abilities. You can have delirium and ADRD at the same time. In fact, new research reveals that delirium is a strong predictor of new ADRD cases. About 15 percent of older adults admitted to SNFs after being hospitalized have delirium, and patients with delirium have a nearly 13 percent increased risk of receiving a new diagnosis of ADRD over the next four years.

Delirium and ADRD can be difficult for healthcare practitioners to tell apart, and older adults can have both conditions at the same time. However, the two conditions have not been studied together in older adults admitted to skilled nursing facilities.

In order to learn more about the relationship between delirium detection and a potentially premature or inappropriate diagnosis of ADRD, researchers conducted a study. They based their findings on their examination of Medicare data from 2011-2013 for new nursing home admissions. The study was published in the Journal of the American Geriatrics Society. Continue reading →

Importance of Preventing Delirium in Hospitalized Older Adults

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Journal of the American Geriatrics Society Research Summary

Though fever and respiratory problems are typically the most common symptoms of COVID-19, worrisome neurologic symptoms also occur in older adults. For example, in a study in Wuhan, China, 36 percent of older COVID patients had neurologic complaints, such as dizziness, pain, sleep disturbances, and problems with balance. Eight percent had impaired consciousness.

What’s more, geriatrics experts suggest that older age is also a risk factor for delirium, a term that means “sudden confusion.” Delirium refers to an abrupt, rapid change in mental function that goes well beyond the typical forgetfulness of aging. The result of abnormal functioning of the brain, delirium requires the attention of a healthcare professional.

Healthcare practitioners have seen delirium affect patients hospitalized with infectious diseases, including severe respiratory diseases. Delirium can mean that a person has suffered an acute brain failure, which could be caused by dehydration, psychoactive drugs, or infection. Delirium can increase the length of an older adult’s hospital stay and can cause mobility problems as well as difficulty thinking and making decisions. This can lead to older adults’ need for long-term care and raises their risk of death.

In severe cases, COVID-19 causes serious lung problems. When this happens to someone hospitalized for the virus, the patient may need mechanical ventilation to help them breathe, which can lead to delirium.

A recent study showed that 26 out of 40 patients with severe COVID-19 infection had signs of delirium. But despite this early evidence, we know little about the effects of delirium on people with COVID-19. A team of geriatrics experts from the University of Sao Paulo, Brazil, created a study to learn more about delirium in older adults hospitalized with COVID-19. Their study was published in the Journal of the American Geriatrics Society.

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Does Having Alzheimer’s Disease and Dementia Affect Severity of Delirium?

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Journal of the American Geriatrics Society Research Summary

Forms of dementia, including Alzheimer’s disease, gradually affect your cognitive function by harming your memory and your ability to think and make decisions. By 2050, experts project that 13.8 million older adults in the United States will develop Alzheimer’s disease and related Dementias (ADRD). Although Alzheimer’s disease is the most common form of dementia, other forms include Lewy Body dementia, frontotemporal dementia, and vascular dementia—all of which have upsetting consequences for people with dementia and their families.

Since no cure or treatment yet exists for ADRD, healthcare providers currently focus on preventing the treatable risk factors that can lead to dementia. This strategy could potentially slow the onset and progression of ADRD.

Hospitalization poses risks to people with ADRD and can have life-threatening consequences, including predisposing us to delirium (the medical term for a rapid change in mental state, often marked by confusion), a decline in mental or physical function, being admitted to long-term care facilities, and even death.

In particular, delirium can worsen the course of an illness, quicken physical and mental decline, lengthen hospital stays, and cause higher rates of hospital re-admission and death. One in 8 hospitalized people with ADRD who develops delirium will have at least one serious problem, including cognitive decline, possibly leading to admission to long-term care or death.

Here’s the good news: Experts say 30 to 40 percent of delirium cases are preventable. But until now, we have not studied how delirium and its severity affect hospitalized older adults with and without ADRD. Continue reading →

New Study Suggests Cautions About Antipsychotic Medications for Hospitalized Older Adults

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Journal of the American Geriatrics Society Research Summary

Delirium (sudden confusion or a rapid change in mental state) remains a serious challenge for our health care system. Delirium affects 15 to 26 percent of hospitalized older adults and can be particularly problematic because those experiencing the condition may interfere with medical care or directly harm themselves or others. Besides behavioral therapy and physical restraints, antipsychotic medicines are among the few therapeutic options healthcare providers can use to ease delirium and protect patients and caregivers—but antipsychotics also come with risks of their own.

To learn more about the effect of antipsychotic medicines on older hospitalized patients, a research team created a study published in the Journal of the American Geriatrics Society. This study included information from hospitalized patients at a large academic medical center in Boston.

The researchers looked specifically at death or non-fatal cardiopulmonary arrest (heart attack) during hospitalization.

The researchers learned that adults taking “first-generation” or “typical” antipsychotic medications (medicines first developed around the 1950s) were significantly more likely to experience death or cardiopulmonary arrest, compared to people who did not take those drugs. Taking “atypical” or “second-generation” antipsychotics (so named because they were developed later) raised the risk for death or cardiopulmonary arrest only for people aged 65 or older.

In the past, other studies have suggested that typical antipsychotic medications could cause sudden death, and that atypical antipsychotics could raise peoples’ risks for falls, pneumonia and death. What’s more, another large study also suggested that both types of antipsychotic medicines posed a risk for fatal heart attacks.

Despite these known risks, atypical antipsychotics are often prescribed for people in the hospital. One recent study of patients at Beth Israel Deaconess Medical Center in Boston found that antipsychotics were prescribed for nine percent of all adults who were hospitalized for non-psychiatric causes.  Another large recent study found that using antipsychotics to prevent or treat delirium did not lower the risk for death, did not lessen the severity of delirium or shorten its duration, and did not shorten the time people spent in the intensive care unit (ICU) or their hospital length of stay.

“Delirium is common in older hospitalized patients and difficult to treat, but antipsychotic medications should be used with caution regardless of age,” said the authors.

This summary is from “Antipsychotics and the Risk of Mortality or Cardiopulmonary Arrest in Hospitalized Adults.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Matthew Basciotta, MD; Wenxiao Zhou, MS; Long Ngo, PhD; Michael Donnino, MD; Edward R. Marcantonio, MD, MSc; and Shoshana J. Herzig, MD, MPH.

 

Physical and Mental Exercise Lower Chances for Developing Delirium After Surgery

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Journal of the American Geriatrics Society Research Summary

After having surgery, many older adults develop delirium, the medical term for sudden and severe confusion. In fact, between 10 and 67 percent of older adults experience delirium after surgery for non-heart-related issues, while 5 to 61 percent experience delirium after orthopedic surgery (surgery dealing with the bones and muscles).

Delirium can lead to problems with thinking and decision-making. It can also make it difficult to be mobile and perform daily functions and can increase the risk for illness and death. Because adults over age 65 undergo more than 18 million surgeries each year, delirium can have a huge impact personally, as well as for families and our communities.

Healthcare providers can use several tools to reduce the chances older adults will develop delirium. Providers can meet with a geriatrician before surgery, review prescribed medications, and make sure glasses and hearing aids are made available after surgery (since difficulty seeing or hearing can contribute to confusion). However, preventing delirium prior to surgery may be the best way to help older adults avoid it.

A team of researchers from Albert Einstein College of Medicine designed a study to see whether older adults who are physically active before having surgery had less delirium after surgery. The research team had previously found that people who enjoy activities such as reading, doing puzzles, or playing games experienced lower rates of delirium. The team published new findings on physical activity in the Journal of the American Geriatrics Society.

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