Delirium

The prevalance of delirium in dementia is well known in the hospital setting as well as in the home setting. Delirium is a sudden change in cognition and alertness and has many causes. A change of environment that is confusing, such as being in an emergency room or inpatient setting, an infection that perhaps the person cannot describe its impact on him are two major causes of delirium. Sundowning, a common increase in confusion in the late afternoon is a form of delirium. Caregivers do well to plan a way to structure that time of confusion to meet the needs of the person with dementia. A quieter environment, few if any demands on the person cognitively, perhaps company that is calming (sitting with the person, walking with the person) may help. I have a theory that sundowning is like a toddler's meltdown in the late afternoon; being over-stimulated or having lack of stimulation impacts the ability of the person to cope with demands on him. In the hospital this might be a time for a snack, calming music or a staff member sitting quietly with the elder or walking the hall with him. Group activities should be soothing and fun rather than taxing cognitively. A sensory room might fill the bill for a patient that cannot tolerate a group.