Caregivers Can Help Assess Whether Older Adults are Dealing with Delirium

Journal of the American Geriatrics Society Research Summary

Delirium is a sudden change in mental status that often occurs when older adults are in the hospital or after they have surgery. More than 20 percent of older adults may experience delirium.  The condition can lead to longer hospital stays, the need to be placed on a respirator (a machine that helps you breathe), long-term changes in your cognitive (mental) health, physical disability, and even death.

Acute illness (illnesses that happen suddenly, as opposed to chronic conditions that you live with over a longer period of time), surgery, and medications can contribute to delirium. In addition, disrupting regular routines may trigger sudden confusion or changes in behavior for certain people.

When healthcare professionals don’t recognize or diagnose delirium, it can delay an older person’s recovery.  Prolonged delirium can have a lasting impact on health and well-being. What’s more, delirium is distressing for caregivers—the family or friends involved in caring for an older adult. In hospitals, healthcare professionals screen (“test”) for delirium. However, despite routine screening, more than 60 percent of older adults with delirium are not diagnosed in hospitals.

In a new study, published in the Journal of the American Geriatrics Society, researchers set out to learn whether caregivers could use existing questionnaires and other tools to detect delirium on their own. The researchers reviewed 6,056 scientific papers about delirium screening. They specifically were looking for proven methods that caregivers could use in home settings.

The researchers identified six tools that caregivers could use. Each one took just several minutes or less to use and had 11 items or fewer to complete. Three tools could be completed by the caregiver alone.

According to the researchers, using these caregiver-centered delirium detection tools, caregivers are generally able to identify delirium symptoms more easily than healthcare professionals who may be less familiar with the person being evaluated. Having caregivers test a person for delirium also makes it easier for the caregiver to be alert for delirium throughout a person’s hospital stay. As a result, caregivers may be able to notify healthcare professionals of changes in mental status sooner, potentially leading to earlier and more frequent diagnoses for older people under their care. Engaging caregivers in delirium detection may also decrease caregiver distress. Many studies have shown that caregiver involvement in health care helps improve patient and caregiver outcomes.

Overall, caregiver-centered delirium detection tools enable caregivers to improve delirium detection. The tools can help to reduce the challenges that can accompany undiagnosed delirium. No risks associated with these tools have been reported. The researchers suggest that future studies should monitor caregiver use of delirium detection tools.

 This summary is from “Caregiver-Centered Delirium Detection Tools.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Brianna Rosgen; Karla Krewulak, PhD; Danielle Demiantschuk MA; E. Wesley Ely, MD, MPH; Judy E. Davidson, DNP; Henry T. Stelfox, MD, PhD; and Kirsten Fiest, PhD.

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