Delirium

Delirium – Information for patients, families and Friends

 

It is our hope that this article will help you learn more about:

What is Delirium?

  • The signs and symptoms
  • How it can be prevented and
  • What families, friends and caregivers can do to help
  • Where to find more information

What is Delirium?

Weaving Secret Riddle Confusion Thread Patterns

Delirium is a condition that causes a person to be confused. It is a physical problem (a change in the body) that can cause temporary change in the person’s thinking. Delirium usually starts over a few days and often get better with treatment.

Delirium can happen to anyone, anywhere. But, it often happens when someone is in the Hospital

 

Once identified, delirium is often treated as a medical emergency. Treatment is put in place right away because it can be a risk to patient safety.

 

Delirium can cause patients to slip and fall or to feel a lot of emotional and spiritual distress. A person with delirium may not be able to understand when people are trying to help them. They may become angry with family and hospital staff. They may start to think that everyone is against them or are trying to harm them. Some people with delirium may want to call the police to get help.

Delirium is like being in the middle of a very strange dream or nightmare, but the person is having these experiences while they are fully awake.

 

What is the risk of delirium?

  • About 20 out of 100 patients admitted to hospital will experience.
  • About 70 patients out of 100 admitted to the intensive care unit will experience delirium. 

 

What causes delirium?

Delirium can be caused by:

A Physical illness (that brought someone to the hospital)
  • Someone who is ill can have changes in their body chemicals, become dehydrated (not enough water in the body) or get an infection, such as a bladder infect or urinary tract infection. These kinds of problems can cause delirium.

 

Medications

  • The medications the hospitals use to treat illness or control pain can cause delirium

 

Is delirium the same as depression or dementia?

No. Delirium can happen more often in people who have dementia or depression, but it is different.

Delirium happens quickly. It can come and go at any time. This does happen with dementia and depression.

Patients with delirium cannot focus their attention. This is different from patients with dementia and depression.

 

Types of Delirium

There are 2 types of delirium:

  1. Hypoactive delirium

This type of delirium happens most often in elderly patients but can affect anyone at any age.

Patients with hypoactive delirium may:

  • Move very slowly or not active
  • Not want to spend time with others
  • Pause frequently when speaking or not speak at all
  • Look sleepy
  1. Hyperactive delirium

This type of delirium is easier to recognize.

Patients with hyperactive delirium may:

  • May be worried and afraid
  • Be restless (not able to stay still or have trouble sleeping)
  • Repeat the same movement many times
  • Experience hallucinations (seeing something or someone that is not really there).
  • Experience delusions (believe something that is not true).

At times a patient can have both hypoactive and hyperactive symptoms.

 

What are the signs and symptoms of delirium?

A check list:

Disorganized thinking                                                      YES                NO

Saying things that are mixed up or do not make sense

Difficulty concentrating                                                   YES                NO

Easily distracted or having difficulty following what is being said

Memory changes                                                                YES                NO

Not able to remember names, places, dates, times or other important information

Hallucinations                                                                     YES                NO

Seeing or hearing things which are not real

Having delusions                                                                YES                NO

Thinking or believing things which are not true or real

Feeling restless .                                                                 YES                NO

Not able to stay still, trouble sleeping, getting out of bed

Changing energy levels                                                     YES                NO

Changes from being restless to being drowsy or sleepier than usual

 

How can delirium be prevented?

All patients should be carefully screened (checked) for these factors that may cause delirium:

  • Hearing problems
  • Vision problems
  • Not enough water in the body (dehydration)
  • Not being able to sleep or other sleep problems
  • Dementia, depression or both
  • Difficulty getting up and walking around
  • Medication being taken
  • History of alcohol or recreational drug use
  • Chemical changes or imbalances in your body
  • Low oxygen in your body
  • Other health condition or illness

Having trouble:

  • Thinking clearly, reasoning, remembering and judging
  • Concentrating
  • Understanding
  • Express ideas

 

How is delirium be treated?

  1. The health care team helps the patient stay safe and calm
  1. They will try to find the cause of the delirium. Often, there is more than one cause. They also make sure any factors they find are not caused by another medical condition
  1. Then they will address the factors or ease the symptoms.

This could include:

  • Reviewing and changing medications
  • Provide fluids to rehydrate
  • Correcting chemical problems in the body
  • Treat infections
  • Treating low oxygen levels

 

What can family and friends do to help?

Family and friends and caregivers can all help to prevent delirium for their loved ones in hospital.

 

Keep a careful watch for the signs and symptoms of delirium

  • If you see any signs that could mean delirium talk with your health care team right away. Family members are often the first to notice these small changes.
  • Use the signs and symptoms check list and factors list listed on this article to guide your findings.

 

Help with healthy eating and drinking while at the hospital

  • Ask what is right for your loved one before they eat and drink.
  • Make sure they have their dentures (if needed).
  • Encourage help with eating. Feel free to bring their favourite foods from home, check with the health care team about foods they should not eat.
  • Encourage them to drink often, if that is right for them.

 

Keep track of medications

  • Share a complete list of their prescriptions and any over the counter medications they take with the health care team… including the dosage.

 

Help with activity

  • Ask what is right for your loved one before starting any activities.
  • Talk to the team about helpful and safe activities.
  • Help them sit, stand and walk.

 

Help with mental stimulation

  • Make a schedule for family and friends to visit. This will help your loved one feel safe and comforted.
  • Speak to them in a calm, reassuring voice.
  • Tell them where they are and why they are there throughout the day. If possible, place a large sign in their room or write information on it.
  • For example, you could write: Today’s date, weather, where they are and their room number… this will help them stay connected.
  • Give them instructions one at a time. Do not give too much information at once.
  • Bring a few familiar objects from home, such as photo albums and their favourite music. If your loved one needs special care to prevent the spread of infection, check with the care team first.
  • Open the curtains during the day time.
  • Talk about current events.
  • Read the newspaper out loud or use talking books

 

Help them with eyesight and hearing

  • Make sure they wear their hearing aids or glasses, if they need them.
  • Make sure there is enough light in the room.
  • Help them use a magnifying glass, if they need one.

 

Help them rest and sleep

  • Reduce noise and distraction.
  • Soothe them with handholding, a massage, a warm drink or music.
  • Bring a night light, but check with the health care team first.
  • Use comfort items like their favourite pillow and blanket.
  • Limit the number of visitors who come to see your loved one until the delirium goes away.
  • The health care team may not give your loved one sleeping medications because it could make delirium worse.

 

Take care of yourself

It is not easy to be with a person with delirium, even though you may understand the problem

  • Make sure to look after yourself and get some rest. Go out for short walks, remember to eat and drink fluids to keep up your energy levels.
  • It may help to share your thoughts and feelings with someone. Feel free to speak with the health care team.
  • Try not to become upset about the things your loved one may say during their delirium state. People with delirium are not themselves. In many cases, they will not remember what they said or did.

Who can I talk to if I have more questions or concerns?

There are many members of the health care team who can offer help and support. Talk with your doctor or nurse and any member of the health care team, including a Psychiatry, Spiritual Care or Social Work departments. They will answer any questions or concerns you may have about delirium.

 

Delirium should go away or be greatly reduced with the right kinds of treatment… although in some cases some of the symptoms may remain for an extended period of time.

More information can be found on these helpful websites:

Delirium Mayo Clinic                     www.mayoclinic.com/health/delirium/DS01064

Delirium MedlinePlus                   www.nlm.nih/gov/medlineplus/delirium.html

 

Videos:

Youtube – How to recognize Delirium             www.youtube.com/watch?v=hwz9M2jZi_o

Many other videos choices will be available when you log on to this site.

 

Living Longer, Healthier & Happier

Women Wearing Colorful Bathing CapsPrepare Yourself – To live longer, healthier and happier

If I’d known I was going to live this long, I’d have taken better care of myself.” So said Eubie Blake, the great ragtime composer and pianist who was still performing at the age of 99, the year before his death. Let’s face it: old age is what lies ahead. If you’re 40 or 50 or even 60, you might not give much thought to the health challenges of aging. But just as planning for future financial needs is important, so is planning for optimum health in our later years.

 

What should you prepare for, and how?

Medical experts express about the major health issues that may lie ahead. While some diseases, such as Alzheimer’s and certain cancers, continue to confound researchers, a great number can be prevented, forestalled, or minimized with a healthy lifestyle and regular health screenings. Sharon Brangman, MD, AGSF, spokeswoman for the American Geriatrics Society, says, “The more you do in middle age to prepare yourself for successful aging, the better.”

Obesity and Metabolic Syndrome

About three-fourths of adults aged 60 and older are overweight or obese. Obesity is related to type 2 diabetes, cardiovascular disease, breast and colon cancer, gall bladder disease, and high blood pressure.

More than 40% of adults 60 and older have a combination of risk factors known as metabolic syndrome, which puts people at increased risk for developing diabetes, cardiovascular disease, and certain cancers. It is characterized by:

  • Waist measurement greater than 40 inches in men, 35 inches in women (apple-shaped body)
  • Triglyceride level of 150 mg/dL or higher
  • HDL “good” cholesterol level less than 40mg/dL in men, 50 mg/dL in women
  • Blood pressure of 130/85 or higher
  • Fasting glucose level of 110 mg/dL or higher

“Women in, and post-menopausal stages tend to accumulate fat around the waist and hips, and men get the gut,” says Brangman. “The best way to fight it is with increasing exercise, reducing alcohol intake — because a lot of alcohol calories go right to the gut — and reducing calorie intake. Also, increase your healthy fat intake — omega-3 fatty acids and unsaturated fats. And eliminate trans fats completely because there’s no safe amount of those.” She also advises avoiding foods sweetened with high-fructose corn syrup. The common sweetener is found in everything from sodas to breakfast cereal to low-fat yogurt. “In middle age, we should eat foods as close to naturally prepared as possible.”

Arthritis

Arthritis affects nearly half the elderly population and is a leading cause of disability. “Old injuries from playing weekend warrior or high school football, and years of wearing high-heeled shoes catch up with us,” says Brangman. “And arthritis in the knees is the price we pay for walking upright on two legs.” The keys to prevention: avoid overuse, do steady, regular exercise rather than in weekend spurts, and stop if you feel pain. “The adage, ‘no pain, no gain,’ is not true.” And managing your weight is just as essential for joint health as cardiovascular health. The Framingham osteoarthritis study showed that a weight loss of just 11 pounds could reduce the risk of developing osteoarthritis in the knees by 50%.

Osteoporosis and Falls

Osteoporosis and low bone mass affects almost 44 million adults age 50 and older, most predominantly affecting women. According to the National Osteoporosis Association, osteoporosis is not part of normal aging. Healthy behaviours and treatment, when appropriate, can prevent or minimize the condition.

In a given year, more than one-third of adults, age 65 and older experience a fall. Twenty percent to 30% of those who fall suffer injuries that decrease mobility and independence; falls are the leading cause of death from injury in this age group.

“Stop smoking, watch your alcohol intake, get plenty of calcium, and limit foods with high acidic content,” says Brangman. “Avoid sodas. They encourage loss of calcium. Our bodies always maintain calcium, and when there’s not enough coming in from our diet, it comes out from our bones. One reason women are especially at risk for osteoporosis is that if they’ve had children; it takes a whole lot of calcium to develop a baby, and that calcium is taken from the mother’s bones if she’s not getting enough in her diet.” Adults in middle age need 1,000 to 1,200 milligrams of calcium daily.

Vitamin D, “the sunshine vitamin,” is also important. Using sunscreens to protect against harmful UV rays is wise, but sunscreens also blocks the same ultraviolet rays the body needs to make vitamin D.

Furthermore, with age our bodies become less efficient at making vitamin D from sunlight. There is a move to get the FDA to increase the minimum requirement for vitamin D to at least 800, or maybe even 1,000 units. Most multiple vitamins contain 400 units. Make sure you’re getting enough from low-fat dairy products, or take a supplement.”

Weight-bearing exercise also helps to keep bones healthy. “If you’re not exercising, starting at any age is beneficial. It’s never too late, but the sooner the better.

Cancer

Risk for developing most types of cancer increases with age.

As women age, the rate of cervical cancer decreases, and endometrial cancer increases. Sometimes women slack off gynecological exams after their childbearing years, but I still think it’s important for women to get regular exams.”

The risk of prostate cancer increases with age, and black men have a higher rate than white men. Screening should start in your 40s, and at the very least should involve a digital rectal examination.

Lung cancer accounts for more deaths than breast cancer, prostate cancer, and colon cancer combined. “Stop smoking.”

Cardiovascular Disease (CVD)

Younger baby boomers take heed: cardiovascular disease (CVD) affects more than one-third of men and women in the 45- to 54-year age group, and the incidence increases with age. Cardiovascular diseases, which are diseases of the heart or blood vessels, are the leading cause of death in the U.S. and Canada. They include arteriosclerosis, coronary heart disease, arrhythmia, heart failure, hypertension, orthostatic hypotension, stroke, and congenital heart disease.

A healthy lifestyle can reduce the risk of heart disease by as much as 80%, according to data from the Nurses’ Health Study, an extensive research effort that followed more than 120,000 women aged 30 to 55 starting in 1976. Looking at data over 14 years, the researchers showed that women who were not overweight, did not smoke, consumed about one alcoholic drink per day, exercised vigorously for 30 minutes or more per day, and ate a low-fat, high-fibre diet had the lowest risk for heart disease.

If you have high blood pressure, get it under control. It reduces the rate of stroke and heart attacks. People say the medicines have bad side effects, but there are enough medications to choose from that you and your physician should be able to find one that’s right for you.

Prepared foods are loaded with salt. Limit salt intake to control high blood pressure. The minute food comes out of a can or frozen food package or from a fast-food environment you lose control of the ingredients. This is another reason to eat foods as close to naturally prepared as possible.

Vision and Hearing Loss

Age-related eye diseases — macular degeneration, cataract, diabetic retinopathy, and glaucoma — affect 119 million people aged 40 and older, according to the 2000 census. And that number is expected to double within the next three decades.

“Eating foods with high antioxidant content may be helpful in reducing vision loss due to macular degeneration,” says Brangman. “And taking vitamin supplements for eye health may help. A lot of my geriatric patients are taking them now, which may not be as helpful as taking them when you’re younger.”

It also appears that smokers are at higher risk for macular degeneration, so that’s another reason to stop smoking. Regular eye exams should include screening for glaucoma, which is called “the sneak thief of sight” for the fact that the first symptom is vision loss. The disease can be arrested, but vision lost to glaucoma cannot be restored.

The incidence of hearing loss increases with age. Twenty-nine percent of those with hearing loss are 45-65; 43% of those with hearing loss are 65 or older.

Hearing loss takes a toll on the quality of life and can lead to depression and withdrawal from social activities. Although hearing aids can help, only one out of four people use them.

High-frequency hearing loss is common in old age and made worse by a lifestyle that includes exposure to loud sounds. The 40- and 50-year-olds who went to the rock concerts that were so loud they were pulsating in their chests are starting to pay. Another factor is working or having worked in a noisy environment, such as airports or factories.”

Her advice to people at any age: Don’t use earbuds! Any source of sound that fits in the ear canal, such as using Walkmans or iPods, really puts your hearing at risk. If you’re going to use an iPod, don’t put it directly in your ear, and lower the volume.”

She says hearing aids are not an ideal solution for hearing loss. “My patients complain that they magnify the wrong sounds. They keep their $3,000 or $4,000 hearing aids in the nightstand.”

Teeth

The good news is that you’ll probably keep your own teeth, and implants and bleaching can make your teeth look years younger than the rest of your body. Only about 25% of people over age 60 wear dentures today.That’s because of a lifetime of good dental health and diet. Unfortunately, the people who haven’t had a lifetime of good health care and healthy practices are at risk for losing their teeth.The US and Canadian Dental Associations advises brushing twice a day with fluoridated toothpaste, flossing daily to remove plaque, and visiting your dentist regularly.

Mental Health: Memory and Emotional Well-being

Forget what you think you know about memory loss and old age. It is not inevitable. So why do so many people say, “My memory isn’t what it used to be,” or “I’m having a senior moment?” Stress, anxiety, and mental overload are most likely responsible. “Stop multitasking,” says Brangman, who is professor and division chief and geriatric medicine director at the Central New York Alzheimer’s Disease Centre, SUNY Upstate Medical University in Syracuse, N.Y. “Our brains are made for us to do one thing at a time. Multitasking overloads the brain so people aren’t remembering things and get concerned they’re having memory problems.”

Doing the things that keep your heart healthy will also keep your brain healthy. The same blood vessels that go to the heart branch off and go to the brain. Exercise, control your blood pressure, quit smoking, and if you have diabetes, keep it under control.

Staying mentally active is as important as staying physically active. Join a book club, stay up on current events, engage in stimulating conversations, and do crossword puzzles. “The new rage is Sudoku puzzles. They’re absorbing and require a tremendous amount of concentration, and there’s a lot of satisfaction in getting it right.”

One of the perplexing problems of aging is Alzheimer’s disease. About 3% of men and women aged 65 to 74 have Alzheimer’s disease, and nearly half of those aged 85 and older may have the disease. We’re not aware of anything people can do to prevent Alzheimer’s or dementia, but we’re learning new things about the brain every day.

Among all age groups, depression is often an under-diagnosed and untreated condition. Many people mistakenly believe that depression is a natural condition of old age. Of the nearly 35 million Americans aged 65 and older, an estimated 2 million have a depressive illness and 5 million more may have depressive symptoms that fall short of meeting full diagnostic criteria.

When you get older, you’re dealing with life-change issues. Kids leaving home, health problems, loss of parents & friends, and advanced ageing related issues (financial, caregiver arrangements, physical challenges, etc). We notice that all the basketball players are younger than us, and the music and ads are for a younger demographic. He advises anticipating and preparing for the changes to come.

One of the biggest life changes is retirement. Many people have their sense of worth tied up with work. In retirement, depression and suicide rates rise.

Prepare for retirement by thinking about what some call “the second act”. What would you have wanted to do if you hadn’t done your career? Jimmy Carter is a perfect example. After his presidency, he went on to become a humanitarian, working on behalf of international human rights and Habitat for Humanity.”

Recognize that some physical abilities will decline, but giving up sports altogether isn’t the answer. People who are active in sports such as basketball or football should think ahead to activities such as golf or water polo that put less stress on the joints.

Also recognize in your 40s and 50s that parents and grandparents won’t be around forever. In anticipation of their getting old and dying, making contact and tying up loose ends can be useful.

Nurturing your spiritual side may be in order as you get older and face mortality. For many people who have drifted away from religion or spiritual practice, it’s sometimes comforting to reassess that. Do I need to connect with my religion or spend time becoming the spiritual person I want to become? Pay attention to it if it’s important to you.

Finally, just the way you figure out your finances, figure out what you need to make you happy, and if you have a medical problem or mental health problem, how will you deal with it. Make some strategic decisions about how you want to live your life.

Do Your Part

according to the Centre for Disease Control (CDC)Much of the illness, disability, and deaths associated with chronic disease are avoidable through known prevention measures, including a healthy lifestyle, early detection of diseases, immunizations, injury prevention, and programs to teach techniques to self-manage conditions such as pain and chronic diseases . While the future will undoubtedly bring medical advances in treatments and cures… but if you can keep all your parts original, they are the best.

Of course, this is not a road that you must commute alone. You can benefit through a service partnerships with In Our Care – Home Care Services to maximize your independence, mobility, safety and engagement in social and community events.

Please contact us today, to discuss any challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at 

 

 

Slips and Falls: Cause and Affect

Slips and Falls are a valid concern among Seniors: Falls Cause Injuries and Deathmodern stair railing design, stair railing, modern design

Falls account for more than half of all injuries among Canadians 65 years and over. One third of community-dwelling Canadian seniors experience one fall each year and half of those will fall more than once. The likelihood of dying from a fall-related injury increases with age; among seniors, 20% of deaths related to injury can be traced back to a fall. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.

How big is the problem

  • One out of three older adults (those aged 65 or older) falls each year but less than half talk to their healthcare providers about it.
  • Among older adults, falls are the leading cause of both fatal and nonfatal injuries.
  • In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.
  • In 2010, the direct medical costs of falls, adjusted for inflation, was $30 billion.

What outcomes are linked to falls?

  • Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.
  • Falls are the most common cause of traumatic brain injuries (TBI).
  • In 2000, 46% of fatal falls among older adults were due to TBI.
  • Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.

Fall Statistics

A summary of 12 studies cites the following most common reasons for falls. The effect of drugs on the elderly, and the difficulties surrounding medication compliance, are also believed to be the root cause for many of falls incidents. Apart from personal suffering, loss of independence and lower quality of life, the costs of seniors’ injuries to the health system are enormous. Seniors’ falls are also responsible for 40% of admissions to nursing homes.

Hospitalization

Falls account for 34% of all injury-related hospital admissions and 85% of seniors’ injury-related hospitalizations, making this the leading cause of injury-related admissions for seniors. Forty percent of seniors’ falls result in hip fractures and half of those who break their hips will never recover full functioning; women sustain 75–80% of all hip fractures and one in five older adults will die within 12 months of suffering a hip fracture.

Where Injuries Occur

Nearly half of all injuries among seniors occur at home. The bathroom and stairs are particularly hazardous due to the risk of slipping, tripping and stumbling.

Fear of Falling

Seniors who fall may limit their activities for fear of falling again. Yet by limiting activities, they are likely to lose strength and flexibility and increase their risk of falling again. Maintaining physical activity is essential if you wish to prevent falls and injury.

The following areas present the greatest risks for slips and falls:

      • Outside perimeter of the house
      • Stairs
      • Bathroom
      • Kitchen
      • Bedroom
      • Garage/Basement/Workrooms

 

We do installations of grab bars in washrooms or any other area where additional personal security is needed. A cost effective way of reducing slips and falls in any area where vulnerabilities present themselves… to ensure you get around the house safely.

Please contact us today, to discuss any of the above mentioned challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at