Thursday, August 18, 2016

What is Hospital Delirium?

Hospital Delirium
by Guest Blogger Johanna Thomas, Trinitas Elder Life Clinician

A few years ago I visited my 89 year old father in law at the hospital after his hip replacement surgery.  Having been told that the surgery went well and that he was even joking with the nurses, I was surprised to find him acting a little “off”.  He insisted on getting dressed even though we repeatedly told him he was staying for a few days.  Minutes later he tried to tip the dietary associate because he thought we were at a restaurant.  This might not sound alarming for someone who just had hip surgery but I informed the nurse that he was "not his usual self".  When I got home that evening, the hospital staff informed us that my father in law, usually a very pleasant man, had become somewhat restless, angry, and was trying to leave.  For safety, he was restrained and required additional staff supervision for the remainder of the night.  
This is not an uncommon scenario for a hospitalized older patient.  Hospital Acquired Delirium (HAD) is an under recognized but very serious condition.  A person experiencing acute confusion could become disoriented, have bizarre thoughts and ideas, or might experience hallucinations.  Older patients have a higher risk for experiencing delirium.  Dehydration, infection, and/or a side effect of a medication can all be reasons why an otherwise “sharp as a tack” elder could become delirious during hospitalization.  It is important to remember that, unlike dementia, delirium is reversible.  With a few simple steps, caregivers can help in the prevention or reduction of delirium. 

          The Healthcare Foundation of New Jersey (HFNJ) understands the importance of using proven and cost-effective measures to prevent or reduce the onset of delirium, and in 2013 HFNJ awarded Trinitas Regional Medical Center with its first Delirium Prevention Initiative grant.  Trinitas subsequently adapted the Hospital Elder Life Program (H.E.L.P.) model founded by Dr. Sharon Inouye, a pioneer in delirium research and prevention.  The original program allows volunteers to feed patients.  Although our volunteers do not feed patients, they provide bedside companionship during mealtimes to encourage the importance of nutrition.   
        H.E.L.P. consists of an interdisciplinary team and specially trained volunteers who perform daily protocols with patients 65 years and older.  Daily orientation visits, feeding encouragement during mealtimes, bedside therapeutic activities, and non-pharmacological sleep protocols (such as hand massages and soothing music) are part of the structured therapies offered by the HELP volunteers. 
Our H.E.L.P. patients are also offered music from the Medical Library’s World Music Collection.  The collection of world music has been well received, as noted on their surveys, by many of our patients who have been able to listen to music from their native country.  
We have a diverse group of volunteers that consists of college students, graduate students, working adults and retirees.  Most recently, we have added a few highly qualified high school students to our program. 
At home, family and caregivers of at-risk elders can also aide in preventing their loved one from experiencing acute confusion.  The Hospital Elder Life Program website offers tips to help reduce the risk of delirium.  Some include:
  • Prepare a “medical information sheet” listing all allergies, names and phone numbers of physicians, the name of the patient’s usual pharmacy and all known medical conditions. Also, be sure all pertinent medical records have been forwarded to the doctors who will be caring for the patient
  • Bring glasses, hearing aids (with fresh batteries), and dentures to the hospital. Older persons do better if they can see, hear and eat
  • Bring in a few familiar objects from home. Things such as family photos, a favorite  comforter or blanket for the bed, rosary beads, a beloved book and relaxation tapes can be quite comforting
·    Help orient the patient throughout the day. Speak in a calm, reassuring tone of voice, and tell the patient where he is and why he is there
·    Stay with the hospitalized patient as much as possible. During an acute episode of delirium, relatives should try to arrange shifts so someone can be present around the clock
For more information on the delirium prevention, please visit:
        If you would like to be a part of our enthusiastic and rewarding H.E.L.P. Team at Trinitas RMC, please visit and click on “links to application form”. 
You may also contact Johanna Thomas, Elder Life Clinician or Diana Noboa, Elder Life Assistant at (908-994-5620).