Nondrug Approach Can Block Delirium

Most geriatric patients can avoid developing delirium when they follow a simple nondrug therapy when admitted to the hospital, according to a recent report in the journal Archives of Internal Medicine.

"The amount of nonpharmacologic therapy that patients receive is just as important as drug therapy," according to the study's senior author Sharon Inouye, M.D. "This is not something that has been documented in the medical literature previously."

Rates of delirium were lowered by almost 90 percent when patients 70 and older walked three times daily, got more sleep, drank enough fluids and participated in activities such as talking about current events and doing word games.

The study did not single out any one component of the nondrug therapy, Inouye says.

Delirium is characterized by a reduced ability to pay attention to external stimuli or shift attention to new stimuli, disorganized thinking, confusion, sleep disturbances, memory impairment, increased or decreased motor activity and disorientation.

Hospitalized patients with delirium have a 10-fold higher risk of medical complications including death, longer hospitalization and higher hospital costs.

Age, underlying dementia and other medical conditions are risk factors for delirium. Causes include:

• Drug use (especially when the drug is introduced or the dosage is adjusted)

• Electrolyte and physiological abnormalities

• Lack of drugs (withdrawal)

• Infection (especially urinary tract or respiratory infection)

• Reduced sensory input (blindness, deafness, darkness, change in surroundings)

• Intracranial problems (stroke, bleeding, meningitis)

• Urinary retention and fecal impaction

• Myocardial problems (myocardial infarction, arrhythmia, heart failure)

"We know many areas of mental health are nonpharmapologic," says Gary Small, M.D., director of the University of California Los Angeles Center on Aging and author of "The Memory Bible." "We always train doctors to intervene when someone has delirium by making sure the person has a nightlight, is orientated to a new environment and has familiar objects from home. This study shows we can be proactive."

Shortage of specialists

As the baby boomers age, doctors who specialize in geriatric medicine may be in short supply, the Alliance for Aging Research says. By 2030 the United States will need at least 36,000 geriatricians and will fall far short by 25,000, the Alliance says.

Of the 650,000 licensed physicians practicing in the United States, fewer than 9,000 are certified in geriatrics. With the number of physicians retiring or choosing not to be re-certified, this number is shrinking.

Be sure your doctor understands the nuances of geriatric medicine, says Daniel Perry, executive director of the Alliance.

"Delirium is one of those conditions that is part of the cookbook of geriatric medicine," Perry says. "You want to make sure your physician is grounded in good geriatric principles."

External Sources Yale University School of Medicine Alliance for Aging Research University of California Los Angeles Center on Aging

This article was reviewed and updated June 2007.

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