For more than one in five patients over 65, hospital stays are complicated by frightening bouts of confusion known as delirium.

Delirium is disturbing, yet it is common enough that many people think it is simply a side effect of serious illness — harmless in its own right. But research has shown that delirium episodes are in fact dangerous, and may be indications that something else is wrong.

What is delirium?

Delirium is a type of brain dysfunction. Many patients who experience it seem disoriented or have trouble focusing. In more severe cases, patients might become agitated, shout, or see or hear things that aren’t real.

Some patients are more at risk for developing delirium than others. There are many risk factors; common ones include age, immobility, dehydration or malnutrition, and severe illness.

Dementia is the most common risk factor, with two-thirds of delirium cases occurring in people with dementia. However, while dementia is a chronic confused state, delirium is acute — episodes of delirium may come and go.

Delirium usually can be attributed to more than one factor. Patients who have been sedated and placed on ventilators often experience delirium. Other causes include certain drugs, neurological disease, surgery, admission to intensive care, and sleep deprivation.

How serious is delirium?

Delirium episodes have been found to have lasting effects. Many people who experience bouts of delirium go on to have memory loss or other type of mental impairment. Patients who experience delirium are more at risk for loss of function, longer hospital stays and even death. In addition, it’s estimated to add $2500 to the cost of a hospital stay to say nothing of the distress it causes patients and their families.

Despite its seriousness, there is little data widely available that doctors can use to decide how to treat or even how to diagnose delirium. As a result, the condition is not yet well understood by many physicians, nurses and other members of the health care team.

One study that surveyed what health care professionals knew and thought about delirium revealed that most think it is common and serious. Yet very few knew that it was as widespread as it really is, and most did not follow established guidelines that recommend monitoring for it in certain patients. A few even reported treating delirium with a medication that may worsen or prolong it.

Better care may yield better outcomes

It can be difficult to prevent delirium because it is so often caused by a combination of factors. However, there are ways to help lessen the chances that a patient will be affected by it — and many of them are simply good care giving. Dr. Sharon Inouye, a geriatrician at Beth Israel Deaconess Medical Center and director of the Aging Brain Center at the Institute for Aging Research in Boston, has developed the Hospital Elder Life Program (HELP), a new model of care to prevent delirium in the hospital. The HELP program focuses on effective communication with patients, keeping them mobile, helping them get a good night’s sleep, managing pain, making sure they have their glasses and hearing aids and importantly, avoiding overmedication.

Because delirium affects older Americans at a much higher rate than younger patients, the burden that delirium places on the health care system will grow as our population ages. Yet, that burden could be reduced if the condition was better understood. It is clear that more research and training are needed to help health care professionals provide the better care that patients deserve. Furthermore, because delirium is an indicator of quality hospital care for the elderly, policymakers should consider ways to provide hospitals with incentives to implement delirium prevention programs.

Web resources:

• The Hospital Elder Life Program
• Avoid Confusion in the Hospital – Ten Tips
• www.icudelirium.org