Show notes
"Atypical Presentation of Illness when an older adult has an illness or condition that doesn't show up in the typical textbook definition/ ways." - Jamie Smith, MSN, FNP "Mrs. Jones just isn't 'right' today". Subtle, non-specific changes in an older adult may be the first sign that family members and caregivers see when an older adult is developing an illness. In today's episode, we will talk about how changes in mental status (hypo- and hyperactive delirium) can be the first sign of an infection, how some infections are show up differently for younger and older adults (e.g., bladder infections), and how depression shows up differently for younger and older adults. Jamie Smith MSN, FNP, in this episode of This Is Getting Old: Moving Towards an Age-Friendly World, highlights some salient points on how to recognize atypical presentations of illness among older adults. Part One Of 'Atypical Presentation Of Illness In Older Adults'. What Is Atypical Presentation Of Illness? Conventional healthcare education teaches the typical symptoms of common illnesses. However, for older adults, these common illnesses do not show up in the same way. The symptoms are usually subtler and less specific than in younger adults and often are first noticed as a change in mental status, energy level or function (such as a fall or a new onset of losing control of their bladder (incontinence)). Atypical Presentation of Illness means that an older adult will have little or no typical signs and symptoms that usually indicate a specific illness or diagnosis. Failure to investigate atypical presentations in older patients, and identify the true medical problem, may result in undesirable outcomes, inaccurate diagnoses, and the wrong treatment for the illness. Delirium is one way an illness may show up (or "present") and has been attributed to adverse health outcomes. The Seriousness Of Deliriousness: Delirium In Older Adults What is Delirium? Delirium usually develops quickly in a matter of hours or days. Thus, healthcare providers should be well aware of the signs and symptoms of delirium. Doing so may help them recognize atypical presentations of illness and at best help curtail severe medical conditions. Delirium is characterized by a sudden change in attention, awareness, and cognition. Delirium may be hypoactive (meaning the person may be more tired or sleepy than usual but the changes in behavior are subtler) or hyperactive (meaning the person is trying to crawl out of bed or some other active, agitated behavior). Accurately diagnosing delirium in a patient population prone to dementia, depression, fatigue, and other conditions whose symptoms can mirror those of delirium can be challenging. It is estimated that between 32-66% of delirium cases are missed by healthcare professionals. This failure to diagnose delirium has two significant consequences for patients. ✅ First, the patient is presumed to have a condition, often dementia, that they do not have, which leads to false assumptions about prognosis and the possible ordering of inappropriate treatments. ✅ Second, and of equal importance, missing the diagnosis of delirium may cause clinicians to fail to investigate its underlying medical causes. Delirium may indicate a life-threatening condition. It carries an increased risk of functional decline and falls, cognitive decline, recurrent hospitalizations, and mortality. In addition, it can take months to clear, and some older adults may never regain their prior functional level. What does Hypoactive Delirium look like? Symptoms Of Hypoactive Delirium Hypoactive delirium is often missed because it doesn't create a problem for others - basically, this type of delirium is characterized by reduced motor activity, sluggishness, seeming to be in a daze, lack of interest in anything, and reduced alertness. Symptoms in older adults include: ✅ The person "isn't right" – a sudden change in thinking/ mental status, tired (lethargic), staying in bed. ✅ May or may not have a fever ✅ Change in baseline vital signs (heart rate, weight loss, change in appetite) Things that can cause hypoactive delirium include: ✅ Constipation ✅ or an underlying infection Symptoms Of Hyperactive Delirium Hyperactive delirium gets attention! This type of delirium is characterized by increased motor activity, wandering hyper alertness, rapid speech, irritability, and combativeness. Among older adults, common symptoms include: ✅ Behaviors are trying to get out of bed, fighting, fluctuating mental status. Read the full article at www.MelissaBPhD.com/podcast-blog