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Delirium Research

Where Am I?

The overlooked danger of delirium in hospitals

In his mid-80s, Jerry (not his real name) moved to an assisted living facility soon after his wife passed away. He had been diagnosed with heart failure several years earlier, making lifestyle changes to slow its progression. In the final months of his wife's life, his daughter observed that he showed signs of mild dementia doctors later associated with his heart failure.

At the assisted living facility, he experienced shortness of breath and acute lower-extremity edema that resulted in a series of hospital admissions for treatment with an intravenous diuretic. While in the hospital, his mild dementia almost immediately switched to delirium. He was agitated, wandered the halls, and alternated between believing he was in a hotel or had been mistakenly admitted to the hospital. The third time he was admitted, his daughter noted a nurse had given him a detailed handwritten note explaining who he was, where he was, why he was there, and how he was benefiting from being there. The note helped curb his agitation but he remained deeply confused.

Each time he was discharged back to the assisted living facility, his delirium quickly retreated.

In another more severe case, Alice (not her real name) noticed something was definitely wrong with her dad and took him to the hospital to be examined by a neurologist and a geriatrician, following an inconclusive visit with his primary care doctor. Her father, who had a mild form of dementia, had begun to suddenly exhibit behavior changes. "We noticed Dad had begun to alternate unpredictably between incidents of a startling and unusual agitation and confusion, followed by extended periods of unusually heavy sleeping," she says.

Within less than 24 hours of hospitalization, her father, who had capably walked into the hospital, had a serious fall and sustained multiple hip fractures that required emergency hip replacement surgery to repair. He would wind up staying in the hospital for 11 months.

"Although Dad showed some confusion immediately following surgery, it seemed minimal and relatable to his circumstance. Dad was able to interact normally with us and his nurses for a day or so," she recalls. "But by about his second night after surgery, a highly anxious state of agitated non-stop yelling and confusion started. It was alarming and traumatizing, and our family's efforts at his bedside failed to comfort and coax him into a restful calm."

These cycles of agitation, contrasted by cycles of nearly comatose sleep, continued intermittently for his entire hospitalization. Shortly after their father's surgery, Alice and her sister rapidly educated themselves on delirium and became powerful advocates for their father's care—something she strongly advises all families of delirium patients to do.

Read More "Delirium Research" Articles

Where Am I? / Digging Into the Mysteries of Delirium / The Impact of Delirium

Fall 2015 Issue: Volume 10 Number 3 Page 14