DHMC highlights efforts to reduce delirium 

Valley News Staff Writer
Published: 9/25/2023 7:20:38 PM
Modified: 9/26/2023 11:53:10 AM

LEBANON — When Dartmouth Health held the grand opening for its Geriatric Center of Excellence last week, leaders there decided to feature a presentation about delirium.

The center, which used to be called the Centers for Health and Aging, focuses on health care for older adults.

The focus on delirium was a logical decision: The condition — which primarily affects older adults — has gained more attention in recent years as health care providers have increased their efforts to screen patients for it, as well as take steps to prevent it.

“Delirium is a state of acute confusion, typically due to an acute medical condition,” said Dr. Mark Oldham, who gave the presentation at Dartmouth Hitchcock Medical Center. “It could be pneumonia. It could be a blood infection. It could be due to medications.”

Oldham, an assistant professor of psychiatry at the University of Rochester and the president elect of the American Delirium Society who works with patients in medical settings, said that about a third of older adults develop the condition when they are hospitalized. It usually comes on pretty fast, which makes it different from memory disorders including dementia that progress over the course of months and years.

“It’s usually pretty obvious because it’s not the person’s baseline,” Oldham said. Risk factors for delirium can include the complexity of the surgery, the patient’s age, the medication they are on and their health, including if they are considered frail, he added.

At DHMC, providers have included screening for delirium in its “Geriatric Surgical Verification Program,” which focuses on better preparing older adults for surgery and preventing complications, said Ellen Flaherty, vice president Dartmouth Health Geriatric Center of Excellence.

“Delirium in and of itself contributes to longer lengths of stay,” Flaherty said in a phone interview earlier this month. She cited data collected at DHMC in the first quarter of calendar year 2022 that showed patients who are part of the screenings went home one day earlier, were discharged to a skilled nursing facility two days earlier and were discharged to a rehabilitation facility three days earlier than patients who were not enrolled in the screenings.

While DHMC has worked to train staff to notice changes in patients and to take steps to catch delirium earlier, it is not without its challenges.

“Because of our profound workforce issues and a high percentage of … traveling nurses, that complicates ensuring that every staff person who encounters an older adult has training in how to manage a patient with delirium and dementia,” Flaherty said. Checking for delirium is part of Dartmouth’s mandatory patient assessment. “We also think about, ‘how do we prevent delirium from happening?’ ”

Some of the prevention is environmental and includes opening shades in patients’ rooms and making sure people are oriented to their surroundings. Staff also make sure patients are aware of what day it is and what season.

“We also focus on ensuring that somebody has the eyeglasses and their hearing aids because very often if somebody can’t see and they can’t hear you can imagine how that could contribute to some confusion,” Flaherty said.

Families can also play a role in helping recognize and prevent delirium. Flaherty said that members of a patient’s support system should report any changes they notice in their loved ones to medical professionals so they can intervene.

If the delirium is brought on by dehydration, for example, providers can treat the underlying symptoms of delirium by making sure a patient is sufficiently hydrated.

“In that regard, being able to pick (up on symptoms) earlier rather than later is really critical because the more you … let it delay, the more deconditioned people get, the more the recovery is delayed,” Oldham said.

Liz Sauchelli can be reached at esauchelli@vnews.com or 603-727-3221.

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