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What are the signs, symptoms and causes of delirium?

Is an older person you care for experiencing a severe and sudden change in mental abilities? They may be suffering from delirium.

A variety of factors, including changes in medication, infections, dehydration, malnutrition, and other medical conditions can cause delirium in the elderly.

While it can be incredibly frightening if someone you care about is acting differently, in some cases, delirium can be a result of something as simple as a urinary tract infection (UTI) which can be simple to treat. However, it can also be a sign of more worrying medical issues. Therefore, it is important to recognise the symptoms of delirium early on so that serious health problems can be avoided or treated.

Older people are particularly vulnerable to delirium as they often have multiple medical conditions that can lead to confusion or disorganisation of thought processes. Additionally, changes in medication can cause a sudden shift in mental state, making it difficult for an elderly person to adjust quickly.

It is important to be aware of the potential signs and symptoms of delirium in the elderly, so that appropriate care can be provided.

We explore the symptoms, causes and treatments for those suffering from delirium.

Symptoms of delirium

Symptoms may include confusion and disorientation, restlessness and agitation, hallucinations, and changes in sleep patterns.

Other signs to be aware of are difficulty with communication and concentration, memory problems, incoherent speech, delusions, a lack of interest in activities or surroundings, fearfulness, or suspiciousness.

It is essential to pay attention to any sudden changes in behaviour or cognition which could be indicative of delirium.

Symptoms of delirium usually present fairly quickly - over a few hours to a couple ofdays and may come and go throughout the day.

Primary symptoms of delirium include:

• Inattention: difficulty paying attention, easily distracted and forgetful

• Disorganised thinking: problems with organising thoughts, confusing conversations or misinterpreting reality

• Altered level of consciousness: varying levels of alertness or awareness and difficulty staying awake

• Psychomotor changes: increased restlessness or agitation, or slowed movements

• Perceptual disturbances: hallucinations or delusions

• Language problems: difficulty understanding and speaking

• Mood disturbances: anxiety, fearfulness, depression or anger

• Changes in sleep patterns: sleeping too much or too little.

If delirium is left untreated, it can lead to the elderly person becoming more confused, agitated or withdrawn. This can have an impact on their quality of life and potentially lead to other health complications such as falls, dehydration, malnutrition, and physical injuries.

It is important to seek medical attention if any symptoms are noticed, as they can be treated with medication and lifestyle changes. Early detection is key in order to provide the elderly person with the best outcomes.

Types of delirium

Medical experts have defined three types of delirium:

Hyperactive delirium

This is potentially one of the easiest types of delirium to notice. Those who are suffering from hyperactive delirium may exhibit symptoms such as seeing things or people that are not there, having rapid changes of mood, appearing restless or being particularly anxious.

Hypoactive delirium

This can be harder to spot in a loved one as symptoms are more focused on being inactive or having reduced activity. Someone displaying hypoactive delirium may appear dazed, sluggish or drowsy. They may also not interact with those trying to communicate with them.

Mixed delirium

This involves showing symptoms of both of the above types. The patient may switch between both being restless and unresponsive/sluggish.

What is a common cause of delirium in the elderly?

An elderly person's mental health, physical environment, and social support system all play a role in their risk of delirium. Delirium occurs when signals in the brain are not being sent and received properly.

The most common risk factor for delirium in the elderly is dementia, being present in up to a third of all cases of delirium in older people.

While dementia is often a factor, delirium can have numerous causes. These include:

Medical causes

Common medical causes of delirium in elderly people include serious illnesses such as stroke, heart attack, infection, kidney or liver failure and even flu.

Medications

Certain medications can also cause delirium, including drugs used to treat pain, anxiety, or depression.

Environmental causes

Environmental factors, such as dehydration and malnutrition, can also cause delirium in elderly people. The presence of unfamiliar surroundings, changes to routine or a lack of stimulation can also be risk factors for delirium.

Social isolation

The effects of social isolation and loneliness on the elderly are well documented. Research has found that social isolation can be a significant contributor to the development of delirium.

Other risk factors for delirium in elderly people include alcohol use, sleep deprivation, or a sudden change in environment. In fact, staying in a hospital can often trigger delirium in the elderly as already unwell patients are put in an unfamiliar setting.

Delirium in hospital

Around one-third of hospital patients over age 70 experience delirium at some point during their hospital stay. The hospital environment presents very specific issues as it combines many of the risk factors that can induce delirium, including illness, an unfamiliar environment and also lack of sleep.

Delirium or dementia?

Delirium and dementia can be easily confused, as they both involve changes in cognition. It is important to note that delirium is a sudden onset of confusion and can cause rapid changes in the elderly person's behaviour, whereas dementia is a progressive decline over time.

It's entirely possible that someone living with dementia can also suffer from delirium. However, dementia is not a cause of delirium. Therefore, it is important to look for any sudden changes in behaviour or cognition which could suggest delirium, which should be addressed as early as possible.

It's important to recognise the difference between these two conditions as they require different types of treatment and care. If an elderly person is experiencing symptoms of delirium, it is important to seek medical attention in order to receive the best course of treatment.

Treatments for an older person suffering from delirium

The treatment for delirium in the elderly depends on the underlying cause, but here aresome of the most commonly used treatments:

• Medication: Antipsychotics and sedatives may be prescribed to help manage any disturbances in mood or thought patterns caused by delirium.

• Therapy: Cognitive behavioural therapy (CBT) may be recommended to help the patient understand their condition and regain control.

• Social support: Having family, friends, or carers present can provide emotional and practical support for the elderly person and reduce the risk of delirium episodes.

• Environmental modifications: Making changes to a person's environment, such as introducing more stimulation or familiar objects, can help reduce the risk of delirium.

• Physical rehabilitation: In some cases, physical therapy may be recommended to help improve balance and coordination, which can reduce the risk of falls.

• Lifestyle changes: Making changes to diet and exercise can help support the elderly person's overall health and reduce their risk of delirium.

It is important that any treatments for delirium in the elderly are tailored to the individual, and their specific circumstances, as what works for one person may not work for another. Additionally, it is also important to remember that some of the treatments listed above may not be suitable for those with advanced dementia. It is always best to speak to a healthcare professional before beginning any treatment.

Identifying delirium: how to help a loved one

Due to the causes of delirium, it's something which can come on very quickly, leaving the older person frightened and confused. If someone you care for may be at risk of a condition which can cause delirium, checking in on them regularly may help you to

identify it early.

SureSafe offers a range of personal alarms and devices that can help. For example, the SureSafe Guardian is a family and friends monitored alarm which allows you to undertake regular "are you ok" checks on a loved one. It also has features including not out of bed alerts and unexpected activity alerts, which can potentially signify that the person may be acting in an unusual way which may indicate delirium.

At SureSafe, we provide a range of personal alarms that can give you and your loved one complete peace of mind that, should you get into difficulties, that help is on hand.

Call SureSafe's team of experts on 0800 112 3201 to discover the best options for you.

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