Treating Delirium: An Often Missed Diagnosis When Earle Helton was hospitalized earlier this year, his medications caused him to suffer an episode of delirium. Helton isn't alone. About one-third of seniors who are hospitalized experience delirium, which is sometimes preventable.
NPR logo

Treating Delirium: An Often Missed Diagnosis

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
Treating Delirium: An Often Missed Diagnosis

Treating Delirium: An Often Missed Diagnosis

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


Not all old age confusion is dementia. Delirium is a common problem that affects more than two million seniors a year when they go into the hospital. Now, health care professionals are trying to teach doctors and families how to deal with it. NPR's Joseph Shapiro reports.

JOSEPH SHAPIRO: Virginia Helton says her husband is a brilliant man. He's a scientist who can explain complex chemistry and physics. But when he was in the hospital last February, she didn't recognize the man who was acting so bizarrely.

Ms. VIRGINIA HELTON: I was feeling very scared.

SHAPIRO: Her husband was talking wild nonsense. He was taking off his clothes.

Mr. EARLE HELTON: I remember quite vividly my desire to escape.

SHAPIRO: That's Earle Helton. He's 79.

Mr. HELTON: And as a matter of fact, I ended up executing, at least one occasion, managed to get through the hospital and underneath one of the surgical beds.

Ms. HELTON: They tied his hands down because he kept trying to get out of bed. And that made him furious. And they did that several times when he was in this state of delirium.

SHAPIRO: Delirium - it's a sudden and frightening onset of confusion. Dr. Sharon Inouye was working at the Boston hospital where Earl Helton was a patient. She recognized he was on an anti-seizure medication that can cause confusion and she stopped the medicine. Inouye says delirium is a common, but largely unrecognized problem in elderly people when they're in the hospital.

Dr. SHARON INOUYE (Geriatrician, Harvard Medical School, Hebrew SeniorLife): What we look for is a person who is having a lot of difficulty answering questions. They often will not make sense. They may hallucinate. They may be very agitated. They may have a totally different personality. You know, very often family members will say to me: Well, he's nothing like that at home.

SHAPIRO: Inouye is a geriatrician at Harvard Medical School and Hebrew SeniorLife. She's seen delirium in her own patients, even in her own elderly father.

Dr. INOUYE: My father wound up getting delirious, even when I was there at his bedside. And I'm an expert in delirium, and I couldn't prevent it from happening.

SHAPIRO: She says because hospital care is so complex and fragmented.

Dr. INOUYE: There were just so many physicians taking care of my father, so many medications. It was really hard for me to keep track of everything. You know, I knew there were certain medications he couldn't tolerate, and I told one group of physicians. And then another group of physicians would prescribe it. And so it just was really quite eye-opening.

SHAPIRO: If one of the world's leading researchers on delirium couldn't protect her own father, you might feel helpless, too. Still, there are things to do, steps based on the workup Inouye and others researchers like Dr. Malaz Boustani at Indiana University's School of Medicine. He says family members can start by being aware of drugs that can cause delirium.

Dr. MALAZ BOUSTANI (Indiana University School of Medicine): There's one class of medications that are really a big factor of triggering delirium. We call them anti-cholinergic medications.

SHAPIRO: These are common prescription and over-the-counter drugs. They include some sleeping pills, asthma medications and antidepressants. Boustani says it's also important for older patients in the hospital to keep using their eyeglasses and hearing aids, and that they're allowed to sleep through the night, because delirium can be triggered by an environment that creates confusion. Boustani recently studied a thousand elderly people who came to an Indianapolis hospital. One-third developed delirium. He says doctors often dismiss delirium because they think it's just dementia in older people. The two are different. Delirium is a temporary form of cognitive impairment. Still, there's a link between dementia and delirium.

Dr. BOUSTANI: And what we found, that if you develop delirium in the hospital and we follow you up to five years, the odds of developing dementia or Alzheimer's disease is five times more.

SHAPIRO: Boustani says researchers are split on the reason. It may be that getting delirium in the hospital can cause a long-term dementia, or it might be that an episode of delirium shows dementia that already exists or is developing. Boustani says that's one more reason why it's important for researchers, doctors and patients to better understand delirium that occurs in the hospital and how to avoid it.

Joseph Shapiro, NPR News.

Copyright © 2009 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.