How To Best Manage Delirium In Alzheimers: Resources For Caregivers
Have you ever noticed a sudden, dramatic shift in your loved one with dementia?
Maybe they recognized you yesterday, but today they don’t know who you are. This sudden confusion can be terrifying for both you and the person with dementia.
In this episode, we focus on understanding and managing delirium in Alzheimer’s, giving caregivers essential tools to handle these unexpected changes with confidence and calm.
What is Delirium?
We explore the difference between delirium and dementia. While dementia is a slow and steady decline, often described as a dimmer switch gradually turning down, delirium acts like a light switch—one moment everything is normal, and the next there’s sudden confusion.
The key takeaway here is that delirium is a rapid, sudden onset of confusion, unlike the gradual changes seen with dementia.
Causes of Delirium
Delirium is typically caused by an underlying medical condition, not by the progression of Alzheimer’s itself. Some common causes include:
– Infections, like urinary tract infections (UTIs) or respiratory issues
– Dehydration
– Medication changes
Understanding the root cause is essential because it often means that with the right treatment, your loved one can recover from delirium and regain some of their former cognitive abilities.
A Real-Life Case Study: Recognizing Delirium in Action
A daughter, who is the primary caregiver for her mother with Alzheimer’s, suddenly faced a crisis when her mother no longer recognized her. The mother became frantic, looking for her daughter all over the house, even though her daughter was right there in front of her.
This real-life scenario illustrates how disorienting and emotional delirium can be for both the caregiver and the person living with dementia. By sharing this story, the host helps listeners understand that they are not alone and that these situations can be managed with the right strategies.
How to Manage Delirium: The PEACE Framework
Lizette introduces the PEACE framework, a powerful tool for caregivers to help manage situations involving delirium. This framework breaks down as follows:
Person: Focus on the individual living with dementia. What is happening with them medically and emotionally?
Environment: Has something changed in their environment that could be contributing to confusion or agitation?
Activity: What level of engagement and stimulation is your loved one receiving?
Caregiver: How are you responding to the situation? Your reaction plays a critical role in calming or escalating the episode.
Evaluate & Educate: After the episode, take time to assess what worked and what didn’t, and educate yourself for future situations.
This framework gives caregivers a clear process to follow, reducing panic and helping them focus on solutions.
Advocacy: The Role of the Caregiver
One of the key points from this episode is that caregivers often need to be strong advocates for their loved ones. Since delirium is usually caused by a medical condition, it’s vital to work closely with healthcare professionals to identify the underlying cause.
Sometimes doctors may not see what’s happening right away, and it’s up to the caregiver to push for further tests or treatments, especially if something feels off.
In one example shared in the episode, a caregiver’s mother was suffering from a mild UTI, which triggered her delirium. The doctor initially hesitated to treat it because it wasn’t severe enough, but the caregiver’s persistence in seeking treatment made all the difference.
Responding with Compassion
The final piece of advice from this episode is to stay calm and compassionate during an episode of delirium. It’s easy to feel overwhelmed, especially when a loved one no longer recognizes you.
However, keeping your emotions in check will help your loved one feel safer and more grounded. After the episode passes, it’s important to reflect on what happened, learn from the experience, and adjust your caregiving strategies going forward.
This episode offers a wealth of insight into managing delirium in Alzheimer’s care. By understanding the causes of delirium, using the PEACE framework, and advocating for your loved one, you can navigate these sudden, frightening changes with more confidence.
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Read More:
Talking About Caregiver Burnout With Michelle Gordon
Check the other podcasts: https://dignicarebydesign.com/category/podcast/
Transcript
[0:00] Hey there, Christian caregiver. Welcome to our Kingdom Focused Dementia Caregiving Podcast, where I teach Bible-believing Christians how to make caregiving easier today,
[0:13] as well as help caregivers reimagine a brighter tomorrow. Today is episode 184, and we are going to talk about how to best manage delirium in Alzheimer’s. This is a resource for caregivers.
[0:32] Recently, I had a client call me in an emergency situation. So part of the services that I offer my clients is they have very direct access to me personally, which makes me significantly different than many people out in this caregiving economy helping other caregivers. Because if you decide at any point to work with me, you have a lot of access to me personally in the programs that I have put together because I recognize that having that interaction with my clients is really what sets them up for success.
[1:13] So one of my clients contacted me in a emergency situation. Her situation is she supports her mother who has Alzheimer’s disease. Her mom lives in an independent living area. Situation. And our goal in working together is to be able to keep her mom in independent living as long as we can, using some paid caregiver support in order for her mom to be able to transition from independent living straight to a memory care without going into assisted living in order for her to maintain her autonomy. So that is the goal that we have together, that we are working towards achieving in keeping her mom in independent living. Well, my client called me because her mom very suddenly was very confused, very agitated and concerned because she’s talking to her daughter face to face, but she’s not recognizing her as her daughter and she’s looking for her. She’s looking for her in her apartment. She’s trying to call her on the phone and her mom was beside herself in trying to find her daughter.
[2:30] And her daughter was very stressed at that moment because she obviously recognized she’s standing there talking to her mom related to, you know, I know I’m here, mom, but mom is not seeing her. Mom is not recognizing her right at that moment in time. And obviously this really bothered my client who is her daughter because she’s standing there and she’s feeling powerless and helpless to help her mom because her mom is so upset that she cannot find her daughter. And so this was the situation that my client called me in. And so I really wanted to unpack for you what happened at that time. Period of time. We’re going to use this kind of like a case study so that it’s easier for you to understand that these situations truly occur and these situations have a fairly easy and predictable path that they follow and response that you can take. So I decided to do this as a case study today.
[3:33] So the case study is my client is a daughter whose mom had a sudden and rapid change and what we did to work through the problems so that my client will be able to recognize this in the future again and be able to navigate this with my help if she needs it. But my job is to empower her to be able to recognize these situations occurring independently of me so that she is not stressed and not overwhelmed and not
Understanding Delirium vs. Dementia
[4:03] freaked out when these things happen.
[4:06] So to set the stage, we’re going to talk today about what is the difference between delirium and dementia. Because when you understand the difference between those two things, sometimes it makes it easier when these things occur for you to understand and to know what to do. So these are very practical tips and resources for you as a family caregiver of somebody living with dementia. What is delirium? Well, delirium is a sudden, very sudden, like overnight, within a couple of hours, sudden onset.
[4:47] Of increased confusion, increased disorientation, other changes in cognitive abilities. So we’ll use my client as an example. Up until that day, she recognized her daughter. She knew exactly who her daughter was. She recognized her son-in-law, but overnight, very sudden, in a very short period of time, she did not recognize her daughter at all anymore. And that is one of the biggest differences between dementia and delirium. Delirium is a rapid change, a sudden change, a overnight change, a within a few hours change. It’s not the slow, consistent changes that fluctuate maybe on a day-to-day basis that somebody experiences with cognitive loss. They are sudden changes, like a light switch.
[5:42] So think about delirium as a light switch being on or off, right? It is quick. When you flip the light switch, the light comes on. If you flip the light switch off, the light goes off. It is very sudden. Dementia, on the other hand, is more like a dimmer switch. So it’s slowly being turned down to dark. Sometimes it turns up a little, but it’s consistently moving more towards the going dark. So it’s a slow, constant change. That is the biggest difference between delirium and dementia. Delirium is fast. Now delirium can last for a period of time. It’s not like a light switch being improved. It’s not like a light switch on and off. I have delirium and now I don’t have delirium. Sometimes it is, but for the most part delirium when it starts is like a light switch off. Now when delirium starts to improve.
[6:37] It can be more again like that dimmer switch being turned back on. And sometimes we get as bright as we were before, but sometimes we don’t quite
Causes of Delirium
[6:45] make it back up to that same level of ability that we had before we had our delirium. Now, what causes delirium? What are some causes of delirium? Causes of delirium are typically an infection. It can be a urinary tract infection. It can be an upper respiratory tract infection. It can be a stomach infection. It can be a hanged toenail that’s gotten infected. It can be any type of infection. It can be caused by dehydration, by not getting enough fluids, enough water in our every day, or it can be caused by medication changes. So typically, a delirium is caused by something. It is not just the normal changes in the brain. There’s an external cause for delirium. Delirium can look very scary. People can be hallucinating when they didn’t hallucinate before. An interesting fact about delirium hallucinations is that frequently people will be hallucinating bugs if they have delirium. If people have Alzheimer’s disease, an interesting fact is frequently hallucinating.
[7:52] They will be hallucinating children as opposed to other types of hallucinations. So hallucinations can be common. Agitation can be common. Being very,
The PEACE Framework Explained
[8:03] very anxious can be common.
[8:06] Very, you know, repetitive questions, all of these kinds of responsive behaviors, but their cause is the delirium. So what are we supposed to do? So how do we even think through this? So I’m going to teach you again my peace framework that I reference a lot in this podcast. I have several episodes that I’ve talked about the peace framework. The peace framework is the way I want you to filter through every single thing that happens related to your dementia caregiving journey. Because if you always run it through this filter, eventually what will happen is you will have learned how to speak dementia and you will be able to figure these things out by yourself and have a much better quality of life, a much better relationship with the person that you’re helping who is living with dementia, and overall a much better and easier experience as a family caregiver of somebody living with dementia. So what is the PEACE framework? The PEACE framework pretty much stands for the person living with dementia, the environment that they live in, the activity level that they are engaged in, the caregiver contributions that are a part of the response that we may see. And then the E is evaluate and educate.
[9:32] So person, environment, activity, care partner, contribution.
[9:37] And evaluate and educate.
[9:40] Are you a Christian dementia caregiver struggling to cope? Does dementia caregiving really need to be this hard? Join our free monthly Ask the Dementia Coach monthly meetup and get personalized guidance and support from me, a pastor’s wife, occupational therapist, and Christian Dementia Coach. By blending evidence-based strategies with Christian principles, you can radically improve your caregiving experience. Register now for our next Ask the Dementia Coach monthly meetup today. We limit our registrations, so don’t miss out. Sign up today.
Immediate Responses to Delirium
[10:26] Typically, when we are dealing with delirium in particular, what we are immediately going to think of is what is going on with that person? What was going on with my client’s mom? What is going on right now that has changed? So in our conversation together, I started to ask my client a few questions. I said to her, I’m like, has your mom been, you know, tested for UTI lately or a urinary tract infection? Does she have another kind of infection? So we are immediately looking for a medical problem. Delirium is frequently attached to a change in a medical condition. So immediately my client started having her tested for a urinary tract infection and she actually did have a mild urinary tract infection. And so some of the frustrating things right now in healthcare is that doctors frequently will say, well, it’s not severe enough that we want to treat it with an antibiotic. An infection, a UTI, remains the fastest change in thinking abilities in older adults still to today. An infection, and it’s typically a urinary tract infection. So her mom actually did have a mild urinary tract infection. So there was a medical thing going on. But we can also look at the environment.
[11:53] What was going on in the environment? Did something change in the environment? Was there a move? Has she been staying with her daughter, which she sometimes does, or has she been just in the independent living? What kind of a change in the environment is there? Typically in cases of delirium, we’re not necessarily looking for the activity participation component because there’s usually a medical reason that it happened, but that is what the A stands for. Or C is how we as the caregiver contributes to the situation.
[12:27] And in case of a delirium, how you respond as the caregiver is fine. Vital. I cannot express how vital it is for you as the caregiver to respond. There’s going to be an immediate response to the situation, which is controlling the situation. And then there is going to be a longer response to the situation. So the immediate response that my client had was that she reached out to me, right? That was her immediate response. And then we unpacked the situation. Part of what happened was that her mom was so upset because she wasn’t recognizing her daughter at that moment in time that she wanted to be taken back to her home.
[13:10] Her independent living apartment, and then tore the apartment up looking for her daughter who was standing right there. And that had an immediate response on my client emotionally because her mom wasn’t recognizing her. And so we have been working a lot in the coaching sessions on controlling our emotions when we’re in that particular situation. And she was able to control her emotions to a large extent until she got on the phone with me. And then quite appropriately, that was the appropriate time to let her emotions go. But she managed and handled the immediate response extremely well. She kept her mom safe. She utilized strategies that we had tried. And then we came up with another solution that we will talk about in the evaluate and educate part. But the longer response to the situation is getting the medical help, right? Making sure you take them to the doctor or to the emergency room or urgent care. Now, something that we’re going to talk about in the last point is that sometimes then as the caregiver, you are going to have to be that person’s advocate. And we’ll touch on that again in a little bit. But the first response that we have as the caregiver is absolutely vital. So we control the situation and then we have the longer response, which is implementing a plan or getting a plan.
Evaluating the Situation
[14:32] And then the last part of the PACE framework is evaluate and educate.
[14:36] So delirium in specific is a medical condition that usually precipitates the response, the change, the acute confusion. And so when we are unpacking this, we want to immediately try to get medical help, get her on an antibiotic, take them to the doctor, something to figure out what is going on medically, control the situation. But then as we’ve moved through the situation, we want to evaluate it and we want to evaluate it using four things. What didn’t work? What did work? What could I have done differently? And what did I learn?
[15:12] So in case of my client, what didn’t work was my client was trying to use her cell phone to her mom’s cell phone to call her own phone and answer the phone in front of her mom so that her mom could see that she was her daughter. So she’s looking for her daughter. But what was fascinating in this was that it didn’t work. But her mom could recognize her voice. She recognized my client’s voice and recognized that to be her daughter, but she couldn’t put the two pieces together visually and hearing. So that didn’t work so well. But what did work well was she recognized her voice. And so that was the strategy that we ended up coming up with, what we could have done differently, what she could have done differently. And so what I recommended that my client do is that she use her husband, who was there as well, and her husband stay with her mom because, interestingly enough, she recognizes her son-in-law, but she doesn’t recognize her daughter in that moment. And have my client step out into another room and give her son-in-law the phone and have him call his wife in the other room and give the phone to the person who was having the delirious episode at that moment because she recognized her daughter’s voice.
[16:37] And so by taking the visual away and just stepping out and talking to her, she could have perhaps reassured her. So that was something that we could have done differently.
[16:48] And what did we learn? What did she learn from this episode? She learned to recognize the difference between delirium and as well as dementia. And we added some more strategies, some more ideas.
The Importance of Advocacy
[17:01] Some more things to my client’s toolkit in how to be able to evaluate this on her own in the next time. Now, the last point I’ll bring up today is being an advocate, right? So we first looked at what is delirium, then we looked at how to use the peace framework again to recognize what was going on. And now the third point is now you might have to be that person’s advocate because you.
[17:30] As the primary caregiver, as the spouse, as the daughter, as the granddaughter, whoever you are that knows that person, you know that person better than anybody else. And sometimes tests, as good as they are, do not show an infection, even though the person has subclinical signs of infection, which is the delirium. And so doctors do not know your person. And sometimes you have to keep being the squeaky wheel that gets the oil and keep squeaking and squawking to continue to advocate for that person that there is something wrong. I’ll use myself as an example. I had a patient many years ago. So I was working in a nursing facility where I had a patient who had fallen and because we’re always concerned about a hip fracture, they had x-rayed her hips, but she was having changes in her behavior and she was responding to me differently.
[18:32] And we had, I finally was able to convince them to take it. An x-ray of her wrist. She had fallen and she had broken her wrist, but nobody had picked up on that because we were so focused on the other stuff. So not entirely delirium, but very similar.
[18:48] So something going on with the person and you as the primary person who knows the person that you are caring for better than anybody else, you sometimes have to be the advocate and not take no for an answer. Do it in the right way. Don’t be, you do actually catch more flies with honey
Closing Thoughts and Community Support
[19:08] than vinegar. So you do it in the right way, but do be their advocate. Now, if today’s episode struck you and helped you and you’re struggling with some of these responsive behaviors, or you’re struggling to communicate well with the person that you’re helping, I want to invite you if you need extra help to join our next Ask the Dementia Coach monthly meetup. It’s coming up next week, October the 24th at 6 p.m. In Eastern Standard Time, Daylight Time, whichever it is. I can never remember Eastern Time. And I invite you to sign up and register because in those monthly meetup sessions, I keep participants registering to about 12 because I know not everybody shows up. It is a big commitment. I ask you to be a co-creator of this podcast, which means that you agree to be on the podcast, but you do not have to have your camera on. You do not need to use your own name. We can take away all the identifying factors.
[20:15] I just want to serve you. I want to serve you. And if you have questions, I can guarantee you other people have the same questions that you’re having. So if you do feel like you need some extra help, Join me for these free coaching calls, these Ask the Dementia Coach monthly meetups. They are wonderful opportunities for you to get to know me a little bit better, for me to get to know you a little bit better. And I love serving you in this way. So join me, be a co-creator in this podcast. But if you’re not ready for that, I totally understand it. I’m here for you. Continue to listen to this podcast. I have a free Facebook group, which is the same name as the podcast. And so join the Facebook group. There’s a link in the show notes. Come hang out with me there. And remember that I truly am here to serve you as my community and to do dementia differently.
[21:20] We can do dementia differently. It doesn’t have to be hard. It doesn’t have to be all doom and gloom. We can do this in a kingdom-focused way. We can navigate dementia well, and we can do it together. So join me on Ask the Dementia Coach or any of my other social platforms. I look forward to serving you. I pray for you every single day. And as I try to end all of my podcasts, may the Lord bless you and keep you. And do like, listen, and share these episodes with other people who are in a similar situation as you.
