With two older elders in my family right now, conversations with friends in my age group often turn to the adventures and challenges of supporting older adults. A topic I hear about again and again has to do with unexpected or alarming confusion or agitation of an aging parent who goes to the emergency department, hospital, or has a marked change in a living situation.
The story almost always goes something like this. Someone’s mother or father visits the emergency department or requires a hospital stay. Unexpectedly the individual seems confused, angry, or slightly out of touch. The physician or caregiver asks if the parent suffers from dementia, or maybe they prescribe a medication without asking the question.
The adult children are distressed. Mom or dad has not acted like this, and while there is memory loss, it’s not substantial. More than likely the older individual is experiencing an onset of hospital delirium — which will begin to fade away, though possibly not entirely, when the stressful situation ends.This medical condition is important to note and adult children need to be sure that physicians, who may be rushed or not especially focused on older elder care, know that the onset has been sudden or acute.
Our family’s first experience with this condition came when a 90-year-old family member, my husband’s mother, was taken by ambulance to an emergency department after a fall. The people were kind and the care was superb, but the experience of spending nearly seven hours with a 90-year-old on a gurney (with no chance of moving around because of the IV and monitors) was uncomfortable and exhausting for her. She felt overexposed in the hospital gown. She asked more than once to get off the cart — her back and legs hurt. She became increasingly confused, and the hospital staff kept asking us about her dementia — which she had experienced only mildly.
When she was admitted, continuous disturbances made Mother’s sleep impossible as lights shined, alarms went on and off, doors opened and closed, voices drifted in from the hall, and vitals were rechecked. Her confusion increased and by the next morning, she gave her maiden name when asked and recognized her son but not me, her daughter-in-law.
And then, once we left the hospital most of the confusion began to dissipate, though for days she was more withdrawn than usual. We were fortunate that it was only an overnight stay.
Another elder family member became agitated after a 10-hour wait in the emergency department. Before his wife knew it, he was receiving an anti-psychotic medication, one often prescribed for dementia patients. He had no history of memory problems before he went to the hospital, and he was okay a few days later when he was home, though the experience left him subdued.
Confusion and delirium is indeed an acute condition, one that has often been mis-diagnosed. A 2012 article in the Canadian Medical Association Journal, Hospital-induced delirium hits hard, states:
“A decade or maybe 20 years ago, people would say that it’s an old person and of course they are confused,” says Dr. Angela Catic, a geriatrician and instructor of medicine at Harvard Medical School in Boston, Massachusetts. “That was delirium but everyone accepted it as the norm. Well, it is common, but it’s not normal.”
Interestingly, a move to rehab or even a new assisted living community can also cause confusion, not nearly as serious as delirium, but just as distressing for the individual and family members. “My Mom kept calling me and asking to check out of the hotel,” a friend told me, and she went on to say how agitated and confused her mom was in her new assisted living apartment, something I’ve also experienced when my parents moved to assisted living.
In essence, adult children need to understand and be prepared to address different behavior when an elder is suddenly encounters or is confined in a new place where confusion can possibly occur. Preparation includes talking about their surroundings and ensuring they have familiar items such as hearing aids, glasses, magazines, and even pictures of loved ones or favorite magazines. In an emergency situation mobile phones with solitaire, photos are especially useful.
Elders depend on routine, and when their routines change, we adult children need to understand those changes.