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Nahon, Saharovich, & Trotz

Link of Delirium to Death of Nursing Home Patients

A recent study shows that delirium can be linked to mortality rates in nursing homes. The report, authored by Dr. Martin M. Forsberg of the Rowan University School of Osteopathic Medicine, found that roughly 18% of the nursing home population suffers from delirium. Delirium is a serious disturbance in mental abilities that results in confusion, abnormal thinking or behavior, and affects perception, attention, and mood. Another characteristic of delirium is restlessness.

At first glance, the signs of delirium may look a lot like dementia, which is a byproduct of Alzheimer’s disease, but the two are different conditions. Dementia as a result of Alzheimer’s primarily affects an individual’s memory and intellectual abilities, while delirium is displayed more in abrupt spurts of confusion. One key difference is inattention, as individuals suffering from delirium have trouble focusing on one idea or task. On their face, the two conditions may appear almost indistinguishable, which is why many nursing home patients who suffer from delirium are misdiagnosed as having Alzheimer’s, which means they do not receive the proper medical care.

The two also differ by how they are brought on. Dementia as a result of Alzheimer’s is not always a normal part of aging. Currently, there is no cure for Alzheimer’s. Delirium, on the other hand, is normally caused by a combination of factors that make the brain vulnerable and trigger a malfunction in neuropathic activity. There may be a single contributing factor or a combination of factors including malnutrition, dehydration, sleep deprivation, emotional distress, chronic illness, and surgery or other medical procedures that involved anesthesia. For instance, a patient may suffer from a serious illness while simultaneously facing neglect from caregivers. Certain environmental factors may play a role in delirium. For example, the absence of a clock, television, or phone in a nursing patient’s room has been found to worsen the symptoms of delirium.

Medical evidence can differ on whether delirium on its own causes deterioration in brain functioning which leads to death, or if delirium is a sign that the mind and body are in decline and close to death. Nevertheless, the study presented evidence that delirium has a one year mortality rate among 40% of long term care patients. What researchers do know is that delirium, unlike Alzheimer’s, can present itself suddenly and take time to resolve. During this time, patients are more susceptible to an early death.

Delirium can also be brought on by nursing home neglect. According to Dr. Forsberg’s study, patients who have had to be physically restrained are five times more likely to have delirium. In nursing homes, physical abuse often results from understaffing or inadequately trained employees. Signs of abuse and delirium include unexplained bruising or marks on the patient’s body.

Doctors diagnose delirium based on a number of tests. After researching a patient’s medical history, a mental assessment test is conducted, which focuses on the patient’s mental state, perception, and memory. Next, patients undergo a neurological exam, which helps doctors determine if a certain neurological disease is causing the delirium. Once assessed, it is important to normalize the patient’s environment with stimulation and care. Medications can be administered when necessary, avoiding certain antihistamines and sedatives.

Family members can play a vital role in helping prevent delirium. Many cases of delirium go unnoticed because caregivers may not be familiar enough with patients to know if a patient is acting out of character. If a loved one is displaying sudden signs of confusion or inattention, alert your loved one’s healthcare provider immediately.