Symptoms of post-traumatic stress disorder are also common in people who develop delirium. Only 6 percent were cognitively impaired before their hospitalization.Ĭognitive and memory problems are not the only effects. A year after discharge, 80 percent of 821 ICU patients ages 18 to 99 scored lower on cognitive tests than their age and education would have predicted, while nearly two-thirds had scores similar to patients with traumatic brain injury or mild Alzheimer’s disease. In 2013, Ely and his colleagues published a study documenting delirium’s long-term cognitive toll. Wesley Ely, a professor of medicine at Vanderbilt University School of Medicine who founded its ICU Delirium and Cognitive Impairment Study Group. “The biggest misconceptions are that delirium is inevitable and that it doesn’t matter,” said E. Other research has linked delirium to a greater risk of falls, an increased probability of developing dementia, and an accelerated death rate. Recent studies have linked delirium to longer hospital stays: 21 days for delirium patients compared with nine days for patients who don’t develop the condition. The underlying physiological cause of delirium, once called “ICU psychosis,” remains a mystery. Many cases are triggered by the care patients receive-especially large doses of anti-anxiety drugs and narcotics to which the elderly are sensitive-or the environments of hospitals themselves: busy, noisy, brightly lit places where sleep is constantly disrupted and staff changes frequently. Researchers estimate that about 40 percent of delirium cases are preventable. Preventing delirium is crucial, she said, because “there still aren’t good treatments for it once it occurs.” “Physicians and nurses often don’t know about it,” added Inouye, who directs the Aging Brain Center at Hebrew SeniorLife, a Harvard affiliate that provides elder care and conducts gerontology research. As a young doctor in the 1980s, Inouye pioneered efforts to diagnose and prevent the condition, which was then called “ICU psychosis.” Its underlying physiological cause remains a mystery. “Delirium is very underrecognized and underdiagnosed,” said the geriatrician Sharon Inouye, a professor of medicine at Harvard Medical School. Delirium is estimated to cost more than $143 billion annually, mostly in longer hospital stays and follow-up care in nursing homes.

Regardless of its cause, delirium can persist for months after discharge.įederal health authorities, who are seeking ways to reduce hospital-acquired complications, are pondering what actions to take to reduce the incidence of delirium, which is not among the complications for which Medicare withholds payment or for which it penalizes hospitals. But the condition is common among patients recovering from surgery and in those with something as easily treated as a urinary-tract infection. Patients treated in intensive-care units who are heavily sedated and on ventilators are particularly likely to become delirious some studies place the rate as high as 85 percent. “I tell him it’s more like a train wreck,” said his wife, Marylou. Until recently, he believed he had been in a car wreck. Some patients with delirium are agitated and combative, while others are lethargic and inattentive. Dementia develops gradually and worsens progressively, while delirium occurs suddenly and typically fluctuates during the course of a day. While delirium and dementia can coexist, they are distinctly different illnesses.

The disorder can occur at any age-it has been seen in preschoolers-but disproportionately affects people older than 65 and is often misdiagnosed as dementia. Turpin’s experience illustrates the consequences of delirium, a sudden disruption of consciousness and cognition marked by vivid hallucinations, delusions, and an inability to focus, that affects 7 million hospitalized Americans annually. Instead, her once-astute husband has had great difficulty “getting past the scramble.” “They kept telling me in the hospital, ‘Everybody does this,’ and that his confusion would disappear,” she said. “I tell him it’s more like a train wreck,” said his wife, Marylou Turpin. Until recently he did not remember where he lived and believed he had been in a car wreck. Delirious and too weak to go home after his hospital discharge, he spent months in a rehab center, where he fell twice, once hitting his head. Nearly five months later, Turpin’s infection has been routed, but his life is upended. Doctors tried to quell his delusions with increasingly large doses of sedatives, which only made him more disoriented. But as he battled a life-threatening infection, Turpin developed terrifying hallucinations, including one in which he was performing on a stage soaked with blood. Paul Turpin was admitted to a Tennessee hospital in January, the biggest concern was whether the 69-year-old endocrinologist would survive.

Reason to believe