Crazy For You

We all get confused from time to time. It seems a normal part of aging, or maybe the effects of living in a tightly wound, highly stressed, multi-tasking world. Keeping a grip seems to need more and more of our attention. Trying to find our illusive car keys, or remembering why we went searching for something in the first place, can both frustrate and make for laughable moments at family reunions. We would swear that at times we’re taking leave of our senses.

For our loved ones on medication, or fighting a recent new illness, we must be especially diligent making sure we don’t confuse innocent confusion for delirium. This is a much more serious condition, where an person becomes unable to focus on the here and now. They have trouble maintaining attention, or shift their thoughts quickly away, leaving us wondering just where they went. They can fluctuate from seeming wide awake to almost falling asleep in a brief period. Their altered attention span may be accompanied by visual or auditory hallucinations, hearing voices that others don’t, or seeing things that allude the rest of us.

In hospitalized patients, these symptoms can easily be missed by believing it’s just “old age.” We know now, however, that delirium represents a marker of increased risk of death over the following year after hospitalization. Delirium results from the use of new or more powerful drugs, stress from a surgical procedure or test, or just being immobilized for prolonged periods of time. Patient’s in the hospital with delirium stay longer, have more hospital-acquired complications and are more likely discharged to an extended care facility.

When we visit our friends or loved ones in the hospital, we may be the first to detect this problem. Hospital personnel develop rating scales, or in some cases form teams, to ferret out causes for a patient’s sudden change in behavior. Unfortunately, they can miss subtle forms of delirium—thinking the patient is just lethargic, or slow to get around. Even though they may not pick up on subtle changes in behavior, we would immediately know something’s not right. Bringing our concern to the nurse or physician can be life-saving. Recognizing we’re dealing with a serious form of delirium allows us to quickly make changes in potential causes.

In hospitals nothing’s more important than seeing and fixing these folks with delirium as quickly as possible. By speaking up we may help bring them back to earth, back to their normal health and more importantly, back home where they belong.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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