Guest Expert Blogger:
Leslie Kernisan, MD MPH

Earlier this week, while I was listening to a social work colleague (Mary Hulme of Moonstone Geriatrics) give a talk on dementia at the public library, the following question came up:

“How can one keep Alzheimer’s from getting worse?”

Now, Alzheimer’s disease — the most common underlying cause of dementia symptoms — does slowly get worse no matter what. (Given enough years, it will eventually damage the brain to the point of causing a slow death, which is why Alzheimer’s is a terminal disease.)

But on the other hand, we do know that some things tend to slow the progression of brain decline, whereas other things seem to speed up the decline. In other words, the actions we take — and don’t take — can influence a person’s dementia journey.

In my experience, people often have heard about things that might slow down decline (exercise is one of my favorites).

But it seems to me that people are often much less well-informed about the things that can speed up Alzheimer’s decline. This is too bad, because often it is possible to take actions to avoid or minimize things that might cause dementia to get worse faster.

So today I’m going to write about what I think is the most important of these potentially dementia-accelerating problems: delirium.

Delirium: What it is, why it matters

Delirium is a state of worse-than-usual confusion brought on by illness or some kind of stress on the body or mind. It is especially common during hospitalization.

Although the extra confusion of delirium does tend to get better with time (and of course with the treatment of whatever illness or stress brought on the delirium), it’s very important to know the following facts:

• Some people with dementia who experience delirium never recover all the way back to their previous level of thinking ability. Instead, they settle at a new, lower level of mental ability.
• People who’ve experienced delirium tend to mentally decline more quickly during the following years than people who haven’t had delirium. In this study, having had delirium was linked to thinking abilities declining twice as fast in the year after a hospitalization.
• Hospital delirium is very common in people with dementia. This study found that delirium affected 32% of patients with dementia during hospitalization.

In other words, experiencing delirium is common, and can really speed the decline of Alzheimer’s or another dementia.

This can be scary for patients and caregivers to realize. Fortunately, although it’s not possible to avoid all delirium (people get sick after all, or do need to have surgery sometimes), it ispossible to take steps that have been proven to reduce the chance that an older person will experience delirium while hospitalized.

To learn more about how you can help prevent delirium during an older person’s hospital stay, I recommend this resource for patients and caregivers on the Hospital Elder Life Program website.

What caregivers can do about delirium

If you are caring for someone with dementia, here are three things you can do to avoid mental decline due to delirium:

1. Educate yourself about delirium. For instance, you can learn more about what brings it on, how to have it managed, and how to prevent it. Much of this information is presented in the Dementia and Delirium Solution Center, which I wrote while at Caring.com a few years ago.
2. Be careful about surgery and hospitalizations. If you are considering a surgery that is elective or otherwise not completely mandatory, be very mindful of the risks of accelerating the decline of Alzheimer’s or another dementia. For a sad story of how a family came to regret agreeing to a heart valve repair for an older woman with dementia, read this New York magazine story.
3. Learn to spot delirium in the hospital. If you are a caregiver and your loved one with dementia has to be hospitalized, try to help hospital staff monitor for delirium. Yes, it’s their job to do, but studies have shown that busy hospital workers often don’t notice delirium in older adults. Families can help their loved ones get better care by watching for delirium and getting doctors to promptly address it if it develops.

Leslie Kernisan, MD MPH, is a practicing geriatrician with a special interest in educating and empowering family caregivers. For tips on better healthcare for aging adults, and information about upcoming caregiver education events, visit her website at www.drkernisan.net.

She will be leading free Q & A calls for caregivers on Tuesday, June 24th 3:30 p.m. EST. Please check her website for more details.