BY ANNE C. TABAT
Community Relations Manager
Walker Methodist Health Center
What is delirium?
Delirium is a medical term to describe sudden changes in behavior, memory or thinking. It is not a new condition and the term comes from the Greek meaning ‘off the track”. It is temporary and treatable.
How is delirium different from dementia?
There are a number of different forms of dementia, including Alzheimer’s and they are all slow, progressive and at this time, non-reversible. Delirium is a sudden change that is out of character and it is often preventable, treatable and reversible.
The outward signs of both delirium and dementia can look similar which is why a medical diagnosis is important. In both situations, a person may appear confused, forgetful, anxious or irrational. However, delirium has a sudden, rather than gradual onset.
What causes delirium?
Not all causes for delirium can be identified but delirium can occur following an unexpected hospitalization following a fall or stroke, for instance. An untreated urinary tract infection (UTI) can also cause delirium. Delirium can also occur when a person is on certain medicines such as psychotropic drugs or drugs for dementia.
Is there anything else I should look for that might be mistaken for dementia?
There are other situations where confusion or behavior changes are apparent but that would NOT be diagnosed as either dementia or delirium. Examples of these would be could be changes in vision, hearing or mobility. Illness, grief, depression, epilepsy and other life-changing circumstances should be taken into account before assuming a person has delirium or dementia.
Can a person have BOTH dementia and delirium?
- Delirium is more common among persons with dementia. Because of this, families sometimes assume that a person’s dementia has suddenly become worse during a hospitalization or life-changing circumstance when in fact, that person is suffering from delirium. While treatments for the delirium will not reverse the slow progress of dementia, they can help reduce the confusion caused by delirium so that a person’s activities of daily living are not dramatically changed.
How do I know if it’s delirium and not something else?
There are assessments available to determine if the change in behavior, cognition or memory is delirium, dementia or something else. Common assessment tools are the mini-COG (cognition) test for dementia and the CAM (Confusion Assessment Method) for delirium. The best resource for these assessments is usually the primary physician.
What do I do if I think a person might be delirious?
Speak to their doctor about your concerns and your observations. Ask anyone who knows the person well and has also commented on changes in their thinking or behavior to write down their observations with particular reference to the onset of the confusion. Share this with the doctor as well. Remember that delirium is a relatively sudden shift, not a gradual decline and that a return to familiar surroundings will help reduce the confusion. So this is not the time to look for a new care setting or residence unless required by new physical needs.
How is delirium treated?
Once the cause of the delirium is identified, it can be usually be treated quickly and effectively, either by changing medications that are contributing to the confusion or adding medicines to treat underlying causes such as a urinary tract infection (UTI). Therapies to reduce anxiety and confusion such as aromatherapy with lavender, music therapy, healing touch can also be effective. Time and a return to familiar surroundings also play a big part in reducing delirium.
“Polypharmacy” – A blessing and/or curse
By Tom Mathei
In the epic battle against cancer and other serious health conditions, researchers and clinicians developed what we have come to know as “drug cocktails”. They found that different drugs, used to treat different conditions, could work together to fight one, or more common enemies of the body. Many of the winning combinations of drugs were found to be effective through informed guesses and a bit of pure luck. Knowing that luck played a role reinforced the fact that there were two sides to the medical coin the researchers were tossing. One side of the coin might be a miraculous lifesaver, while the other could produce extremely serious side effects, or even death. In more informed circles these drug cocktails were referred to as “polypharmacy”.
According to Wikipedia.org:
“Pol-y-phar-ma-cy – Polypharmacy is the use of multiple medications by a patient, generally older adults [those over 65 years]. More specifically, it is often defined as the use of four or more regular medications. It sometimes alternatively refers to purportedly excessive or unnecessary prescriptions. The term polypharmacy lacks a consistent definition. Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes. About 21% of adults with intellectual disability are also exposed to polypharmacy.
Although polypharmacy can be appropriate, it is more often inappropriate. Concerns about polypharmacy include increased adverse drug reactions, drug-drug interactions, prescribing cascade and higher costs. Polypharmacy is often associated with a decreased quality of life, decreased mobility and cognition.”
So what about Elvis Presley? What killed him? When Elvis passed away back in 1977 his doctors were baffled. The idea of polypharmacy and the many ways it can present itself just wasn’t the first thing doctors considered. His personal physician was treating him for simple constipation for several months before his untimely death that August. In those days men didn’t talk about such things. Nowadays every other commercial on TV is about making something soft or hard. Many seniors, such as myself, still find such talk or commercials covering such topics to be embarrassing and definitely taboo. Regardless, as computer technology rapidly developed, it allowed millions of correlations, concerning a myriad of topics to be made with a few stokes on the keyboard. As a result, more research was being done at ever increasing speeds. Looking back into Mr. Presley’s medical history with newfound understanding, and access to the number and amounts of different drugs he was taking simultaneously, it is now conjectured that Elvis died of “paralysis of the colon” brought on by polypharmacy. More specifically, the side effects of drug-drug interactions and drug cascading (one drug causes a symptom that another drug is prescribed to address) caused the colon to shut down, making it impossible to move food through his system. Very sad to say, the King of Rock and Roll died a horrific, excruciatingly painful death on his bathroom floor.
It can happen to any of us. When I hit the age of 59 years the wheels came off my health bus. In the space of two years I had spinal surgery, four eye surgeries, heart surgery, a full craniotomy for a brain aneurysm and emergency surgery for a ruptured posterior nasal artery. I had different doctors for every procedure and was taking all the meds that each prescribed. Before the heart surgery I was taking meds to reduce my blood pressure. I was puzzled as to why I was still required to take them after seeing the “after pictures” of my Left Anterior Descending Artery (the widow maker] as wide open as a fire hose. However, I felt considerably worse than before the surgery. Against my wishes and whines I was released from the hospital feeling as weak as a mosquito with an empty tank. I was told to start moving around and I would feel better with each passing day. I did move around as instructed, but kept getting light headed, especially when I bent from the waist. I assumed, because of the severe headaches that intensified with each bend, it was an after affect of the brain surgery. I was wrong. It seemed to get worse with each passing day. It was an easy guess to blame the brain surgery for my headaches. I passed out and “face planted” off my deck, in the food store, at the gas station and all over my home for several years. I tried to avoid any bending as my quality of life lead me into clinical depression.
I finally went to the Mayo clinic in Rochester, MN for a post neurosurgical work up and evaluation. After four days and $18 bazillion dollars spent, I was told flatly, “Of course you have headaches and some dizziness. You had some very serious brain surgery, Tom. What were your expectations? You’re going to have to find ways to work around it.” When they first told me I was clinically depressed, I thought they were out of their minds. After the Mayo visit, I was positive they were correct.
A few months later I went to see our family doctor for my annual check-up. Before leaving his office he handed me my new prescriptions, which I promptly dropped to the floor. I bent down to pick them up. The next thing I remembered were the lights in the ceiling of the ambulance rushing me to the hospital. I couldn’t move, but I could hear everything they were saying to the ER over the radio. My blood pressure was so low I was off their charts and realized they were charging up the heart paddles just like on TV. I finally came back to consciousness surrounded by my wife and three daughters and my cardiologist. Four of them were crying and one of them seemed to be slightly upset with me. My cardiologist had my chart and asked me, “Why in the hell are you still taking the blood pressure meds?” Apparently, after my heart surgery, his order to take me off the BP meds had been missed. I had fallen victim to polypharmacy at the hands of a simple honest mistake.
Here is what I did to insure against making a similar mistake in the future:
- I took control of my own destiny. I started asking good questions and demanding credible answers.
- I thoroughly researched my medical team and validated my choices. I was pleased with all my doctors except my GP or Family Physician. I fired him and found a better one.
- I asked my newest doctor to be my Quarterback. I had all my records sent to him. I scheduled an hour-long appointment with him to make sure we were all on the same page. We reviewed each medication I was prescribed.
- I finally started reading all the small print descriptions of each medication.
- I asked each of my different specialists to copy my GP after every visit with the details.
Sometimes it seems like life just isn’t fair. I can’t help thinking of an old Johnny Carson line, “If life was really fair, Elvis would still be alive and all the Elvis impersonators would be dead.” Take care of yourself and let’s be careful out there.
Choosing the correct home healthcare provider
By Tom Mathei
Aging is a process that begins at birth and simply never stops. All through life we mark some of the more notable moments of aging with birthday parties, celebrating anniversaries, even buying bigger shoes. We accept it all without a second thought. When we are young we really aren’t bullet proof, which is just a state of mind. If you break your arm at the age of 16, you take a few months to recover while sporting a brightly colored cast that all your friends autograph for the fun of it. That euphoria surrounding recovery, at some point in the aging process, turns to trepidation as we slowly glide into the classification of Senior Citizen. Subconsciously we start making adjustments to our behavior based on our age. No more taking two or more stair steps at a time. “Wait a minute. Didn’t I just get new glasses last year?”
I think we can all understand there is a certain amount of denial in Seniors, when it comes to health matters. This makes it more difficult for those who love Seniors, to assist them in ways they need, but are too afraid, or too stubborn to admit. The issue becomes more acute when something “bad” happens. Surprise!! Drop everything and run to the aid of your senior. My dad always used to say, “If you fail to prepare, you are prepared to fail.” As a loved one, or family member allowing yourself to get surprised by a senior emergency is not a crime, but it can stain your heart with unnecessary guilt. Prepare yourself by getting some help from professionals that can assist you in avoiding the many pitfalls of the aging process.
Start by understanding that change is difficult for Seniors. Also understand familiar surroundings, most importantly their homes, provide comfort and confidence for Seniors. With all that being said, it becomes evident very quickly that there are a ton of things to consider. That is where choosing the correct home healthcare provider becomes the most important “moving target” you will encounter. Thinking about the entire journey of aging on the down slope, the things that change become more important, as in more serious. Over the long haul, Seniors staying safely at home with a kindly assist will take more attention as time marches on. The issues can also become more serious and eventually require more skilled home healthcare providers. The best solution is to find a healthcare provider that can transcend the different stages of the aging process.
Identify the services that historically have filled the needs of Seniors. Understand that companionship and help with chores, although very important, only cover the beginning stages of the aging process. To save time and provide seamless professional home healthcare, it would be wise to seek a long term relationship with one trusted provider that can, in laymen’s terms, “do it all”.
Identifying the services a Senior will, or ‘may’ need, can present itself as a daunting task at first blush. Not so, given the technology today. If you break things down to the stages of aging there is a beaten path to the most common needs of Seniors. When you realize you need some help with what is known as “Home Services” there are plenty of lists to consider. Here are just a few:
o Light house keeping;
o assistance with meal preparation;
o monitoring diet and eating;
o getting ready for bed;
o pet care;
o attendant and/or driver services for appointments;
o respite care to give a constant care provider a break
Most in-home healthcare providers are prevented from doing much more than the above services by license requirements designed for the well being of the Senior. However, as the aging process progresses there may come a need for more comprehensive in-home care. Things get a little more complicated as a Senior may need more comprehensive services such as:
o post surgical in home care;
o wound treatments;
o medication alerts and management;
o short or long term rehabilitation;
o memory care;
o skilled nursing;
o assisted living services;
o palliative care for loved ones whose prognosis is grim(one of the most sensitive areas in health management)
If you are lucky enough to find an in-home healthcare provider that can deliver all the needed personal services mentioned above you will have found the proverbial needle in a haystack.
Start your search by asking prospects what type of healthcare provider license they hold. If it is not a COMPREHENSIVE license, I strongly suggest you keep searching for a provider that has the Comprehensive license. This will allow you customize your care plan to fit your Senior’s needs as they change, without having to go on another quest to find a competent provider. If you are lucky, you may even find a Comprehensive licensee that can assist you in modifying the home for the safety, security and convenience of your loved one.
By Tom Mathei
If Baby Boomers attempted to catalog all the technological advances that have occurred during their lifetimes, it might take another lifetime, and they would never catch up. In fact, technology in many areas has grown so rapidly, and dramatically that it has literally overcome our ability to catch up. Seniors that were here before television and jet planes are now using technology never dreamed of in their youth. Technological advances, such as “point and click” features, have given us easy access to other technologies that can save a life, but require caution in their use.
In an article written by Doctor Robert Sheeler, the Medical Editor for the Mayo Clinic Health Letter, he cautions those with pacemakers to “avoid certain sources of electromagnetic interference”. My initial reaction was, ok, I know all about this subject. If you have a pacemaker you just have to stay away from microwave ovens. Wow, was I wrong on that one! In fact, Dr. Sheeler states, “Devices that are unlikely to interfere with your pacemaker include microwave ovens, televisions and remote controls, radios, toasters, electric blankets, electric shavers, and electric drills.”
Apparently, everything I assumed I knew about the risks, or dangers posed for those with pacemakers was wrong. As I read the article I kept thinking about my Mom’s pacemaker. I was my Mom’s personal care assistant before she passed away a few years ago. I monitored her medicine, did light housekeeping, assisted her with living as independently as possible. I wasn’t a professional in-home healthcare provider, but I accepted the responsibility of one. By doing so I may have exposed my mom to many hidden dangers, as described by Doctor Sheeler.
Cultures clash as seniors willingly accept some of the newest tech toys and tools without knowing how they might impact their health. So if the microwave oven is not a threat to those using a pacemaker, what is? To my shock and surprise the article advised users to take precautions when using a cell phone! If the Holy Grail of modern society, the cell phone, actually does present a risk to those that use a pacemaker, what other risks are out there? Dr. Sheel suggests users take precautions to prevent possible life threatening electromagnetic interference with their pacemakers:
- “Cell phones — When your cell phone is on, keep it at least 6 inches away from your pacemaker. When talking, use the ear opposite your implantation site.
- Certain tests and procedures — Before any test or procedure, tell your health care provider that you have a pacemaker. Magnetic resonance imaging (MRI) scans are generally not recommended for those with pacemakers, although there are exceptions. Caution also is warranted with radiation therapy, shock wave lithotripsy, surgical procedures and transcutaneous electrical nerve stimulation.
- Store anti-theft and airport metal detectors — It’s unlikely that these would interfere with pacemaker function if you walk through them at a normal pace. Avoid lingering around them or leaning on them. A pacemaker could set off a security alarm. If security personnel want to check you with a hand-held metal detector, ask for an alternative form of search. To avoid potential problems, obtain an ID card from your doctor stating that you have a pacemaker.
- Power-generating equipment — Industrial settings such as those with welding equipment, generators or high-voltage transformers can interfere with pacemakers. Your doctor can arrange a test in your workplace to determine if it affects your pacemaker.”
Knowledge is power. In the case of technology vs. seniors, knowledge can also be a lifesaver.