Helping to Prevent Symptoms of Confusion in the Elderly
Chris Cooper MSFS, CFP
You may have heard a version of this story before. The hospital from the small town your mother lives in calls you at 5:30 in the morning. An apologetic nurse tells you, "your mother has been acting strangely all night", according to neighbors who brought her in at 2:00 am. She's confused, she doesn't remember where she lives, nor can she remember who the President of the United States is. You have heard that people tend to get senile in their old age, but your mother is only 63. You just spoke to her three nights ago and she was completely coherent. You remember her telling you that she had just been to the doctor for her allergies, with spring coming and the flowers starting to bloom, she was a little congested.
First of all, let's understand something, old people do not get senile because they are old. In recent years, most gerontologists have stopped using the term senility to describe acute confusion in the elderly. Medically, we call this dreaded and sudden onset of confusion, delirium. Delirium is often seen as a disorientation to time and space. It is also seen as impaired memory, disrupted thinking, restlessness, disruptive sleep-wake cycles, anxiety, suspicion and agitation. These symptoms often worsen at night.
The recent press coverage of a past President being diagnosed with Alzheimer's Disease, (an organic brain disease which produces symptoms similar to those of delirium, named for the physician who discovered it), has reinforced a belief many people hold; the mistaken belief that everyone will contract Alzheimer's disease when they age.
Although some scientific research is showing that more people may have this dementing illness, contracting Alzheimer's disease is not an across the board consequence of aging.
Delirium is often brought on by depression, nutritional imbalances and infection, particularly urinary tract infections and respiratory infections. Decreased blood pressure, sensory deprivation or overload, dehydration and drugs can also bring on delirium. Many older persons take a lot of different medications for a lot different reasons. Some are prescribed by the advertisements on TV, and most are prescribed by different physicians. Because it is not uncommon to find dentists, optometrists, and in some states, chiropractors, all prescribing medication for the same person (as his or he family doctor would); the potential for polypharmacy puts many elderly persons in as much risk as not taking the medication they are prescribed.
Below is a list of medications that can cause confusion in elderly persons because of the potential affect of the pharmacokinetics of these medications :
Products with anticholinergic activities are listed below by generic name or classification and brand name
- thioridazine – Mellaril
- amitriptyline – Elavil, Endep
- tricyclic antidepressants – Elavil, Endep, Etrafon, Triavil, Limbitrol
- atropine - Sal-Tropine
- theophylline - Slo-Bid, Slo-Phyllin, Accurbron, Aerolate, Brokodyl, Elixophyllin, Quibron, Respbid, Theoclear, and others
- diphenhydramine – Benadryl, Sleep-Eze, Unisom, Complete Allergy Medicine and many others
- OTC antihistamines – Contac, Actifed, Allerest, Triaminic, Tavist and many others that contain phenylprop HCL and pseudoephedrine HCL
Histamine2 - blocking agents
Analgesics
- merperidine – Demerol
- nonsterodoidal anti-inflammatory drugs (NSAIDs) – Naprosyn, Naproxen
Sedative - hypnotics
- halcion – Halcion, Triazolam
- benzidiazepines – Ativan, Dalmane, Diazepam, Librium, Lorazepam, Restoril, Serax, Tranxene, Valium, Xanax and others
Cardiovascular drugs
- nifedipine – Adalat, Procardia
- quinidine – Qinaglute
- beta blockers – Betachron, Inderal, Propranolol, Cardizem, Cardene, Adalat, Vascor, Vasotec, Lopressor, Lanoxin
Home bound adults are at the most risk for medications causing confusion. In a 1990 study in North Carolina found that among older adults receiving home care, six out of nine most frequently prescribed drug groups were medications that are often associated with drug induced confusion.
If you are wondering if your mother's confusion is avoidable and curable, the answer is a two part consideration. First, there needs to be an awareness of the possible side effects of a particular drug being prescribed. Your physician, pharmacist and/or registered nurse are professionally obligated to evaluate medications and to look for possible symptoms of constipation , urinary retention, blurred vision or dry mouth. These symptoms are often present in confused elderly persons who may be having drug induced confusion.
If your parent is taking multiple medications, be assertive. Make sure at least one prescribing professional is monitoring all of your parent's medications.
Delirium is curable, where as progressive dementias such as Alzheimer's disease are not. Let's always look for a possible cause of confusion before we write someone off as senile.
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