Dementia vs. Delirium
I recently got a call from a member of the Pueblo community whose mother was living at home with him. Pretty suddenly, she started acting quite differently. The changes were so severe, in fact, that he was feeling overwhelmed and ready to find an assisted living situation that offered more help. I was able to direct him to take her to a local urgent care to look for an infection. Sure enough she had a urinary tract infection. Once she was treated she returned to normal and her son was very relieved.
Many families who are trying to take care of their senior family members are poorly educated on the skills needed to take care of the aging. My first advice would be to seek help. Home health agencies and care giver health professionals are willing to help educate you on what all is involved. Don't hesitate to ask the questions.
Getting older brings with it all kinds of quirks. These changes can vary from individual to individual, but there are certain changes that are more universal. One of these is extreme mental changes accompanying any type of infection. This is what is known as delirium. It can be common in people even as early as 60 years of age. Delirium will look a lot like dementia. The difference is that delirium is sudden and severe, but can be treated and cured. Dementia's often show up slowly and progress over time. So if your older family member has sudden mental changes, suspect an infection that needs to be treated as soon as possible.
You might notice these changes while they are living with you or when you go to visit them at their home. Try to stay calm and try to get them to the doctor as soon as you can. I recommend your community emergent care or urgent care. These walk in clinics are different from emergency rooms in that 1) they are much cheaper; and 2) the waits are often shorter and the customer service better. Walk-in clinics are not for true emergencies like heart-attacks, strokes, and septic shock; which could be life threatening. Occasionally, these clinics will tell you to be seen at the emergency room. If an infection is severe enough it will progress to septic shock. If the person is cold, sweaty, pale, and/or shaking and weak; you are better off to go directly to the ER.
There are other reasons that someone could develop sudden mental changes like confusion and dementia type symptoms. Most commonly people can develop electrolyte imbalances which are caused by dehydration, various medical conditions, and/or medication. Good hydration along with drinks like Gatorade (1/2 Gatorade, 1/2 water) and orange juice can help prevent this. There are also vitamin deficiencies that can mimic dementia. If the person is not eating well or not eating quality food this can be the cause. This is known as malnutrition. Finally another sudden onset mental change is caused by strokes.
Strokes are most easily identified when paralysis and/or the inability to speak are present. Confusion is also commonly present. Sometimes mental changes can be the only sign of a stroke. When strokes cause mental changes without other obvious stoke symptoms it is a bad thing because the person is often not able to get medical care for a stroke within the time frame needed to reverse the damage the stroke causes (about 2 hours.) Often times the person has multiple strokes before the problem is identified. This is one reason I stress seeking medical help as soon as possible. Strokes not treated within hours will result in permanent brain damage. So if you know someone is having a stroke get them right in to the ER.
An insider tip: Make sure that they do not fall and hit their head. Doctors are extremely gun-shy about using clot busters which can restore full-functionality to the person suffering stroke. If the person has suffered a head trauma they will be immediately ruled out for clot-buster therapy. In fact, doctors do not like to give elderly care with clot dissolving drugs.
When strokes go undiagnosed and only cause mental changes, the stroke victim is often left with thinking problems that affect their day to day life. This is known as vascular dementia. Its onset can be somewhat sudden and the effects are likely to stay for the long term. Symptoms can vary depending on which part of the brain is affected and they may be bizarre. Often these individuals have been previously been diagnosed with heart problems. I always recommend individuals with heart issues speak with their doctor about risk of stroke. Sometimes strong anticoagulants are recommended but I think everyone should take an enteric coated baby aspirin daily when they get past 50. But talk to your doctor first.
Even though undiagnosed strokes are a possibility, infections are much more common. Delirium is caused by infections, and this is what we are hoping to find and treat at the walk-in clinic. In the elderly, infections are most common in three systems: the lungs, the bladder, and the bowels. The doctor will seek to rule out infection in these three areas. Once an infection is located an antibiotic is usually prescribed and you can expect improvement within 2-3 days. In general, delirium is a helpful indicator that an elderly person is sick and needs treatment. The drawback is that confusion, unsteadiness, and poor safety awareness can lead to life-altering accidents like falls.
So how can we prevent infections in seniors? Viral infections are harder to stop. The only way to avoid these is to be vaccinated, avoid other people who are sick and good hand washing. Viral infections are usually less likely to cause delirium than bacterial infections. But often viral infections lead to bacterial infections particularly in the lungs. The answer to preventing bacterial infections in nearly all body systems is good hydration.
The lung's natural cleaning system moves bacteria out to where the person can cough it out. Hydration is important in keeping this system healthy and dehydration will impair it by letting secretions get too thick to move. Hydration keeps infections out of the bladder mechanically by the flow of urine. Older women in particular are more susceptible to bladder infections because to tube that leads from the bladder to the outside world is shorter than in men. Each woman also has different anatomy and this can sometimes lead to higher susceptibility. In the bowels, hydration keeps feces from getting too hard. Hard stools can sometimes get stuck leading to a blockage. Blockages if left untreated will result in life threatening conditions like ruptured bowel. Soft fecal matter can move through the system with ease. Seniors should have a bowel movement every 2-3 days. Good hydration will facilitate this.
Due to issues that become more common with age, like incontinence or light bladder leakage in women, and prostate problems in men, seniors are likely to remedy these by reducing the amount of fluids that they drink. This can be devastating towards warding off infections and thereby delirium, which can lead to more severe issues. So if you spot symptoms of delirium get right to the doctor and get treated. At the Oasis Assisted Living Home, the caregivers are always watching our residents for early signs of delirium and our staff is trained to help even the most wayward seniors stay hydrated. If you know a senior that could use a trained eye and help staying hydrated and healthy, tell them about us today! We are one of the most family friendly assisted living facilities in the Pueblo, CO area. Your loved one will love our caregivers and home-like senior living environment. It's sometimes difficult to find senior living communities your loved one will be feel comfortable and well taken care of with a skilled nursing staff. You get the peace of mind you are looking for, and they get the excellent home environment they are comfortable with. Oasis Assisted Living Home could be the right assisted living home for both of you!