How to reduce 'sundowning' delirium in elderly patients

Many of the everyday realities of being in the hospital--bright lights, loud and unusual noises, unfamiliar surroundings--appear to contribute to the phenomenon of "sundowning," in which some elderly patients become delirious at night, a doctor in Boston's Cambridge Health Alliance writes in WBUR radio's health blog.

To tackle the problem, many hospitals have implemented a series of interventions to reduce the stressors that contribute to delirium, third-year internal medicine resident David Scales, M.D., wrote in his blog post. The idea is to keep patients oriented by keeping their glasses and hearing aids within reach, getting them out of bed, keeping them well-fed and hydrated, reducing noise and avoiding confusion-causing medications.

"Implementing delirium precautions isn't easy," he wrote. "It requires a change in mindset away from medications to behavioral interventions." Indeed, it's easier to give a sleeping pill than herbal tea and soothing music, he said, but "much more hazardous." 

He also encourages providers to work with families to help prevent sundowning. For example, ask families for baseline information about the patient's typical behavior so clinicians can recognize sudden changes. The care team can also work with the patient's family to develop a plan for self-care and exercise. 

Recent research indicated that clinicians can help diagnose delirium cases by asking hospital older adults two questions: What day of the week is it? Can you recite the months of the year backward?

Meanwhile, hospitals increasingly are opening emergency rooms just for elderly patients, FierceHealthcare previously reported. ER visits can be chaotic and confusing, but specially trained personnel and more comfortable surroundings can reduce confusion. Personnel also are trained to assess dementia and other disorders common to seniors.

To learn more:
- read the blog post