Confusion: It's Not What You Think

What Is Confusion?

Confusion is a symptom. It is a sign of a disease, and a reason for it can always be identified. Mild forms of confusion may pass for normal, but as they become more severe, affected individuals spend more time in unusual behavior.

Confused patients tend to sleep more, have difficulty sustaining conversation and respond with abrupt, brief, mechanical answers. Confusion is recognized by a combination of any of the following features:

1. The patient is awake.
2. The patient is disoriented.
3. The patient has impaired short term memory.
4. The patient has diminished intellectual capacity.
5. The patient exhibits bizarre and uncharacteristic behavior.

There are many dilfferent reasons for a person to appear confused. Some forms of confusion are readily curable, some are treatable and some are terminal. Thus, there should be a thorough search for a cause when confusion is first noticed.

Deciding which medical condition is responsible for the confusion challenges the best gerontologists. The clinical picture can be complicated by the simultaneous occurence of a combination of conditions in the same individual. For instance, the presence of dementia predisposes a person to depression.

When Confusion is Reversible

The speed with which the confusion progresses is a crucial piece of information. Most treatable conditions will have a rapid onset, whereas dementia, an untreatable form of confusion generalls affects the individual gradually. The following reasons can be the cause ot an acute change leading to confusion;

Depression: Some studies have estimated that about one in three elderly people experience some form of depression during their life

2. Social isolation: Lack of social interaction and prolonged lonliness can precipitate bizarre behavior and confusion.

3. Infection: Fever alone can be responsible for confusion. In general, confusion which results from fever or infection is called delirium. A delirious patient appears drowsy and sick, whereas a demented patient is wake and ready to go. As elderly individuals age, their brains tolerate fever less well. Urinary tract infections and pneumonia can lead delirium which will often clear up after treatment with antibiotics.

4. Strokes: The only sign that a person is experiencing a stroke may be confusion. These individuals are usually identified by concomitant weakness or some other neurologic abnormality.

5. Diabetes: If blood sugar drops to low levels (hypoglycemia) a person can become confused. Giving sugar to such a patient causes a complee reversal of the confusion.

6. Heart failure: As this condition worsens, a patient's need for oxygen increases. Confusion occurs when someone who needs supplemental oxygen is not receiving adequate amounts.

7. Drugs: Many drugs which physicians prescribe can lead to over sedation or confusion in the elderly patient. Some of these medications include narcotics used for pain treatment, antidepressants and antipsylotics used for treatment of psychiatric disorders and sleeping pills. Often these medicines are used at the recommended dose for adults, but elderly people may have side effects at these levels. For this reason, physicians should use the following adage when prescribing medications for the elderly: Go low and go slow (i.e., use low doses and icrease them cautiously and slowly). Thus, before a medication is abandoned, its dosage can be adjusted.

8. Change of environment: Moving an elderly person from a residence or hospital to a nursing home, from one nursing home to another can lead to a confusional episode. The move may be considered a life-threatening event by the frail elderly as their social network is shattered or they struggle to assimilate into new and strange surroundings.

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