DEAR DOCTOR K:

A friend recently told me that his elderly aunt had to stay a few days in the hospital after a surgery. While there, she developed mental confusion that he called delirium. What surprised me was that he said this is fairly common. Why would a hospital stay cause delirium?

DEAR READER:

Being a hospital patient can be a frightening experience for anyone. Unfortunately, some patients -- particularly older ones -- develop delirium. This can make the hospital experience truly terrifying.

Delirium is a temporary condition, in this case brought on by the unfamiliar surroundings of a hospital. You're correct that delirium is a state of mental confusion. People with delirium have great trouble organizing their thoughts. Their memory becomes poor. They may have hallucinations, seeing or hearing people and things that are not really there. They may talk to people who are not there.

Delirium usually comes on suddenly, and symptoms can change unpredictably. People with delirium can be anxious and restless. They can be a threat to themselves -- in their confusion, they can try to get out of bed and wander around. That's a real problem when they have multiple tubes (like intravenous lines) in them.

Delirium can be upsetting for family members. I remember one patient of mine, a man of great intelligence and a very strong personality. Pretty much everyone -- family, friends, co-workers -- deferred to him. He was supremely rational and fair, and always in command. I'll never forget the expression on his daughter's face the night she visited him in the hospital and saw her proud father issuing instructions to an empty room.

Although delirium is a temporary condition, it unfortunately can be a sign of bad things to come. People who develop delirium are at higher risk in the future for developing permanent dementia, requiring institutionalization, and premature death. That's true regardless of their age and how sick they are.

What is it about hospitalization that can trigger delirium? We don't know all the answers. Alcohol withdrawal, dehydration, various medications and general anesthesia can all contribute.

Maybe the most important reason is that people are in an unfamiliar setting. They don't have normal cues to go by. Their glasses or hearing aids may have been removed in order to complete a procedure. This loss of sensory input can cause confusion. Lack of daylight or access to news of current events can increase disoriented feelings. Lastly, hospital procedures, schedules and noises can interfere with sleep, which can lead to confusion.

If someone you love develops delirium while in the hospital, do what you can to keep him or her oriented. Bring pictures of family, clocks and calendars to place near the bed. Visit as often as possible.

Finally, understand that this disturbing state is temporary. Back home, they will become themselves again. They will have little memory of the strange way they were acting in the hospital. Sometimes I've seen family members tell their loved one how strangely he or she behaved in the hospital. There's no point in doing that. They couldn't help it.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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