A recent front page New York Times article highlighted the phenomenon of hospital delirium which, according to the American Geriatrics Society, is suffered by 30 percent of  hospital patients over the age of 70 and even higher percentages of intensive care and post-surgical patients.  The condition which can include inexplicable disorientation, hallucinations, and bizarre and aggressive behavior can affect individuals whose capacity was never in question before hospitalization and who will fully recover.  Delirium can apparently be triggered by many factors including infection, medications, surgery, pneumonia, and invasive procedures like catheterizations that cause elderly patients to experience anxiety.  Although doctors once dismissed it as a reversible and temporary condition, it is now apparent that the presence of this delirium has significant medical, social, and legal ramifications.  Patients with delirium are likely to have longer hospital stays, to have to delay necessary procedures, and to require more attention from doctors and nurses.  But the longer term consequences are also daunting—according to the New York Times, 75 percent of patients with delirium end up in nursing homes, five times the rate of nursing home placement for elderly patients without delirium.   And once elders are institutionalized, it is sometimes hard for them to return home.

Advocates should be alert to the phenomenon of hospital delirium and understand that although it is more common in persons who also suffer from dementia, it is a temporary condition from which elders often recover.  Immediately pursuing guardianships, conservatorships, nursing home placements, sales of elders’ homes and property, and other life-changing and dramatic events based on an elder’s episode of delirium during a hospital stay may be unnecessary and inappropriate.   Just as elders may experience intense but temporary and reversible episodes of lack of capacity from urinary tract infections, drug interactions, electrolyte imbalances, and other causes, hospital delirium can prompt both families and professionals to make inaccurate assumptions about an elder’s future needs and abilities.