Delirium in elderly hospital patients can increase length of stay, risk of death

The occurrence of delirium in elderly hospital patients in recent years has gone from what doctors once believed to be a "reversible transient phenomenon" to a growing cause of death for such patients, the New York Times recently reported. Nearly 33 percent of patients ages 70 and older are affected by the condition according to the American Geriatrics Society, which can stem from everything from medicines and infections to operations and catheter insertions. 

In a study released earlier this year, Dr. Malaz Boustani with the Indiana University Center for Aging Research concluded that the length of hospital stays and the likelihood of ending up in a nursing home both increased in patients experiencing delirium. Such patients wound up staying in the hospital six days longer than normal, with only 25 percent able to avoid being sent to a nursing home for extra care, the Times reported. 

"It's terrible, more dangerous than a fall," Boustani said. 

Adding to the problem, the condition is often wrongly diagnosed as simply being agitation or confusion. Furthermore, some doctors remain in the dark about how to treat such patients, turning to antipsychotics when such drugs might not be compatible with other medications being taken. 

"We would have to build 100 more floors to keep everybody until they cleared their delirium," Dr. Julie Moran, a geriatrician at Boston's Beth Israel Deaconess Medical Center told the Times. "There are times when we could be working round the clock seeing patients with delirium." 

For now, "delirium-prevention programs" are a starting point for keeping the condition under control. Dr. Sharon Inouye, a Harvard Medical School professor, created one such program at her hospital, according to the Times. In that program, schedules are adjusted around the patients' sleep needs, and mind and body exercises like walking and word games are encouraged to keep patients lucid. 

For more information:
- read this New York Times piece
- here's the abstract of Boustani's study
- here's a second study on delirium in older ED patients