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Preventing Delirium in Older Patients During Hospital Stays

Oghenefejiro Okifo | MD

Medically reviewed by Oghenefejiro Okifo | MD, Harvard Medical School | Henry Ford Hospital - Detroit, MI on October 26th, 2024.

Key Takeaways

  • Hospital-acquired delirium affects up to 50% of patients over 65, with episodes typically developing within 24-72 hours of admission and lasting 3-7 days if untreated.
  • The Hospital Elder Life Program (HELP) reduces delirium incidence by 40% through structured interventions targeting six key risk factors: cognitive impairment, sleep deprivation, immobility, visual/hearing impairments, dehydration, and medications.
  • Bringing essential items like glasses, hearing aids, dentures, and familiar objects from home can reduce disorientation risk by maintaining sensory function and cognitive anchors.
  • Antipsychotic medications should be avoided for delirium treatment as they can worsen confusion and increase mortality risk by up to 1.5 times in elderly patients.
  • Family caregivers who stay overnight or visit frequently can reduce delirium duration by an average of 1-2 days through consistent reorientation and emotional support.

Hospitalization can be a disorienting experience for older patients, with about half of people over 65 experiencing episodes of delirium during their hospital stays. Delirium is a sudden change in mental status that can lead to an increased risk of falling, requiring nursing home care, and developing cognitive impairment and dementia.

What Causes Delirium in Older Patients?

Several factors can contribute to the development of delirium in older patients during hospitalization:

  • Disruption of daily routine

  • Introduction to new caregivers

  • Difficulty sleeping through the night

  • Effects of anesthetics or sedative medications

The Hospital Elder Life Program (HELP)

Dr. Sharon Inouye, professor of medicine at Harvard Medical School, recognized that delirium in older patients isn't an inevitable consequence of hospitalization. She and her colleagues developed the Hospital Elder Life Program (HELP), which is available at 200 hospitals in the United States.

Preventing Delirium in Older Patients During Hospital Stays

HELP involves identifying patients at risk for delirium when they enter the hospital and assigning them to receive special care to minimize six major risk factors associated with delirium:

  1. Cognitive impairment

  2. Sleep deprivation

  3. Immobility

  4. Visual impairment

  5. Hearing impairment

  6. Dehydration

Studies have found that HELP is associated with significant reductions in the percentage of patients who develop delirium, fewer falls while in the hospital, shorter hospital stays, fewer nursing home admissions, and a lower rate of cognitive and physical decline.

Tips for Patients to Avoid Delirium

If you are scheduled for a hospital stay, there are several things you can do to minimize your risk of developing delirium:

  • Gather your medical records and prepare a "medical information sheet" listing your allergies, physicians, pharmacy, medical conditions, and medications.

  • Bring essentials like glasses, hearing aids, fresh batteries, dentures, and familiar items like family photos, books, or music.

  • Set up a support team of family and friends to visit you during your hospital stay.

Tips for Caregivers to Help Prevent Delirium

If you are a caregiver for an older patient, you can help prevent delirium by:

  • Arranging for family and friends to visit in shifts and stay overnight, if possible.

  • Working with nurses to encourage the patient to eat, stay hydrated, and participate in rehabilitation therapy.

  • Being vigilant and notifying nurses or physicians immediately if you notice signs of confusion, memory problems, or personality changes.

By understanding the risks of delirium and taking proactive steps to prevent it, older patients and their caregivers can help ensure a safer and more successful hospital stay. For more information on delirium prevention, visit the National Institute on Aging and the Harvard Health Publishing websites.

The Bottom Line

Successful delirium prevention requires proactive preparation before hospitalization and systematic intervention during the stay, focusing on maintaining normal sleep, mobility, and sensory function. Simple steps like bringing familiar items and arranging family support can significantly reduce both the likelihood and severity of confusion episodes. If you notice sudden confusion or personality changes in a hospitalized loved one, Doctronic can help you understand the symptoms and next steps.

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