Some time ago, I was contacted by a concerned family about the condition of their elderly mother, an 80-something-year-old woman with mild cognitive decline. She had fallen at home, landing backward, and developed a large, extensive hematoma down her thigh. She was taken to the emergency room, where, fortunately, no fractures were found, and after a short hospital stay, she was discharged home.
However, once she returned home, things took a turn for the worse. The family noticed that she was barely responding to those around her and was unable to function at all. She wasn’t engaging with her environment, and while she didn’t appear to be in overt pain, any attempt to move her or get her to stand resulted in significant agitation and resistance. She wasn’t drinking much, if at all, and the family couldn’t recall the last time she had a bowel movement.
Diagnosing and Managing Delirium
When I arrived to assess her at home, it became clear to me that she was experiencing delirium. Delirium is an acute, often temporary state of confusion, characterized by altered consciousness, difficulty concentrating, and impaired communication. It can develop rapidly, particularly in older adults and especially in those with any degree of cognitive decline. However, delirium is not exclusive to those with dementia and can affect anyone under the right circumstances.
Delirium is usually triggered by a combination of factors, and in her case, there were several:
Pain from the large hematoma.
Dehydration, as she wasn’t drinking enough fluids.
Constipation, which hadn’t been addressed after her hospital stay.
The hospital admission itself, which is a common trigger for delirium in older adults.
Avoiding Hospitalization and Supporting Recovery
The key to treating delirium is identifying and addressing the underlying causes. We managed her pain with appropriate analgesics, ensured she was properly hydrated, and treated her constipation. Within a few days, her condition began to improve noticeably, and within a couple of weeks, she returned to her usual level of functioning.
But the story didn’t end there. During her recovery, routine blood tests conducted at home revealed a drop in her hemoglobin levels. The nurse from the health service recommended an immediate trip to the emergency room. However, after a thorough discussion with the family over the phone, it became clear to me that the anemia was most likely due to the large hematoma I had observed during my initial visit. Instead of rushing her back to the hospital, we opted for close monitoring and started her on iron supplements. Over time, her hemoglobin levels improved, and the anemia resolved completely – all without an unnecessary hospital visit.
The Importance of Ongoing, Personalized Medical Support
This case highlights the critical role of an experienced geriatric physician in providing personalized, home-based care. For older adults, especially those with cognitive decline, each hospital visit carries the risk of worsening their overall condition, increasing confusion, and even exacerbating delirium. By offering tailored care at home, we can stabilize their condition, enhance their quality of life, and avoid unnecessary hospitalizations that can do more harm than good.
