Delirium is a sudden brain dysfunction that affects an estimated 10 to 20 percent of hospital patients and 80 percent of intensive care patients, according to the Association of Critical Care Nurses. “Delirium can be very sudden, coming on within an hour or days after an illness or medical event,” said Dr. Kimberly Quigley, a psychiatrist at Parkwest Medical Center. Delirium most often follows infection, surgery, a drug reaction or drug and alcohol abuse.
“Delirium is just a change in someone’s ability to be aware of their environment because of an acute medical illness,” said Quigley. “It’s very scary seeing your family member go through delirium. They may talk about green people running around the room. They may be agitated or pull at their lines and tubes.”
Older adults are especially at risk of delirium because they’re more sensitive to anesthesia and illnesses. An estimated 30 to 40 percent of elderly hospitalized patients experience delirium at some point during their hospital stays. Delirium can be life threatening, Quigley said.
“If confusion lasts a long time, we may never get them back,” said Quigley. “There’s a 50 percent mortality rate with delirium and an increased risk of overall decline in health.”
Patients with delirium tend to recover poorly from surgery, or they never return to prior health. “The longer they have it, the worse it is as well,” said Quigley. “But if we can identify it from the outset, we can treat it.”
Parkwest Medical Center recently set up a “Delirium Team,” an interdisciplinary group of managers and administrators who are working together to prevent and treat delirium across the hospital. The hospital also runs a Senior Behavioral Health unit (see accompanying article), for older patients who need extra help recovering from delirium and other behavioral issues. Throughout Parkwest Medical Center, the staff takes steps to prevent delirium in every medical specialty. For example, as patients come out of surgery, the hospital plays soothing music or the sound of running water.
“This calms them and reorients them to night and day,” said Quigley. “You can actually cut down on the amount of medications you have to give people if you soothe them with music.”
Patients are encouraged to get out of bed as soon as possible, because exercise is known to prevent and lessen delirium. And pain medications are closely monitored, because in many cases they can make delirium worse.
“Delirium is not something psychiatry alone can treat, it’s a system-wide problem,” said Quigley. “Treating it involves every part of the hospital, occupational therapy, physical therapy, nutrition, pharmacy, all of these people have come together to treat the whole person.”