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Confusion in older adults-understanding “delirium”

Posted in: Scottsdale psychiatrist-Thoughts about current events- Apr 20, 2012 No Comments

Confusion in older adults-

More highly recognized by laypeople as a relatively abrupt onset of confusion in older adults, delirium plagues so many patients yet it is severely underdiagnosed and under-recognized   Many physicians do not recognize what this is because the symptoms appear to be completely psychiatric. While psychiatric in appearence, the confusion in older adults is usually medical in nature.  Although it is very hard to seperate medical v. psychiatric since I believe that psychiatry is simply one branch of medicine, but for simplicity, I will differentiate medical as more classic non-psychiatric illnesses and psychiatric as the more obvious classic symptoms people think of.

What is Delirium then? In general it is a relatively rapidly onset of confusion in older adults and other medically compromised, people. Several criteria exist to officially diagnosis the problem but the gist of what happens is somebody who is functioning normally, with no apparent problems with personality, memory or behavior, begin to act very different.  They often hallucinate or become very paranoid, even of family members. Confusion in older adults presents with symptoms including :disorientation to enivorment, to place, time and even themselves.  They begin sleeping all day and are wide-awake all night. They are often very energetic and ansy (often mistaken for being “manic”), however othertimes they can be virtually comatose with limited psychotmotor movement.  Many families simply tell me they do not recognize their loved one anymore whey they are inflicted with delirium.

To make things more complicated, confusion in older adults who aslso have an underlying dementia, such as Alzheimers, are very susceptible to falling into this delirium state due to the fact their brain is already compromised.  Confusion in older adults with dementia also is much slower to remit and is often an endless cycle of episodes of confusion unless aggressive diagnosis of the underlying medical issue is implemented.

So what causes the confusion in older adults?  The list of causes is literally hundreds of problems long but there are a few common problems that family members can be aware of and catch, which may prevent this going undiagnosed or untreated.

Common causes of confusion in older adults include-urine infections are probably the most common cause.  Any infection including pneumonia or sinusitis is enough to cause delirium in geriatric folks.  MEDICATIONS.  I want to highlite this because this is so common yet so completely preventable. There are some very common medications that you should keep an eye out for that are prescribed often in elderly-oxybutynin (Ditropan), tolterodine (Detrol),ativan, xanax or klonopin. Elavil (all tricylclic anti-depressants), bentyl, and ranitidine (zantac).

If you have any family members on any of these medications be aware these are common causes of personality change and depression in all age ranges but specifically elderly people or medically ill.  Some are very sedating, others are called “anti-cholinergic” drugs which means they block transmission of acetylecholine in our brains which is what happens in someone with dementia. In essense some of these mimic an alzheimers-effect.  Some have both properties.

More often than not confusion in older adults is reversible and treatable by diagnosing and treating the underlying problem or removing the responsible medication. Keeping people’s circadian rythym intact by exposing people to proper daylight and dark at nighttime, and some medications can be used short-term if necessary to reduce symptoms.

I have seen too many people go undiagnosed and delirium is never caught. The best thing I can do is to educate the families about confusion in older adults and the concept of delirium. The more people understand, the higher chance they will be able to recognize early symptoms of delirium and provide assistance to doctors who may not recognize this conditions which is unfortunately extremely common.

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