It's not clear exactly why, although specialists say delirium is especially bad for an already damaged brain. But the researchers, and independent Alzheimer's experts, agree that caregivers need to know the risk so they can help a loved one with dementia avoid the hospital if at all possible.
"It's a very stressful time, being in the hospital," says lead researcher Tamara Fong, of the Harvard-affiliated Beth Israel Deaconess Hospital and Hebrew SeniorLife in Boston. Often families tell her, "Dad was never the same after he had that surgery and he was confused."
It's a challenge even for health professionals. Psychiatrist Leslie Fuchs watched in disbelief as her mother, who'd had slowly worsening Alzheimer's for several years, rapidly disintegrated during a stay in a New York City hospital last year.
Relatives had called 911 when Thelma Fuchs, 79, suffered what appeared to be a brief seizure. That problem quickly cleared up but the hospital was reluctant to discharge her with it unexplained. Over a few days, Fuchs became increasingly distraught, tried to sneak into other rooms, and wound up being prescribed some antipsychotic drugs, her daughter recalls.
Leslie Fuchs insisted her mother be sent home, where she calmed down and no longer needed the medications. The family has taken steps for more at-home care in hopes of avoiding future hospitalizations.
"She has to be in an environment that's familiar. She can't make a new memory but her old memories, that's what kind of keeps her together," Leslie Fuchs says. At home, she notes, family members "still are the decision-maker. As soon as you're in an emergency room, you kind of can lose that."
Some 5.4 million Americans have Alzheimer's or similar dementias, and the disease is on the rise as the population rapidly gets older. The disease will cost Medicare and Medicaid about $140 billion this year alone, according to the Alzheimer's Association. There is no cure, and much of the cost is from treating not the dementia itself but other health conditions that dementia can aggravate. Alzheimer's patients gradually lose the ability to manage their diabetes, high blood pressure and other chronic ailments, or even to convey that they're feeling symptoms until an illness becomes serious, explains William Thies, the association's scientific director.
Earlier this year, University of Washington researchers reported people with dementia are more likely than other seniors to be hospitalized, especially for conditions such as pneumonia, urinary tract infections, worsening heart failure or dehydration that might have been treated in the doctor's office if they'd been caught early.
The new study took a closer look at potential health consequences of hospitalizations. Fong's team examined medical records for 771 Alzheimer's patients who were living at home and fairly high-functioning, to see what happened if they wound up in the hospital. About half did, mostly for things like fainting or falls, pneumonia and chest pain. A quarter suffered delirium during that hospitalization.
Each year, about 4 percent of the patients who weren't hospitalized entered a nursing home and 2 percent died. Yet 29 percent of the hospitalized Alzheimer's patients wound up in a nursing home as did a surprising 43 percent of those who suffered delirium, Fong found.
Of those who survived the initial hospitalization, 9 percent died in the following year, as did 15 percent of those who'd suffered delirium, Fong reported Monday in the journal Annals of Internal Medicine.
The study can't explain the link. It's possible that people who wound up in the hospital or delirious already had begun deteriorating more than their non-hospitalized counterparts. Fong would like to compare hospitalized Alzheimer's patients with those who get at-home care for the same conditions, such as advanced urinary tract infections, to see if avoiding the hospital makes a real difference.
For now, "it is perfectly clear that hospitalization is very hard on people with Alzheimer's disease," and that delirium especially is a threat, says the Alzheimer's Association's Thies.
What's the advice for families?
• Be alert for any new symptoms, which could be as vague as irritability from pain, and seek care early to avoid a hospitalization. Also learn to manage Alzheimer's behavioral problems such as hallucinations at dusk before they escalate into unmanageable anxiety, Thies says.
• If a hospital stay can't be avoided, ask if the medical center tries to minimize delirium with private rooms, avoiding waking the patient at night, and limiting time in the emergency room.
• A family member also should stay with and reassure the patient, make sure they have their glasses or hearing aids, and bring in familiar items, Fong adds.