The March 2012 issue of the Journal of American Medical Directors Association features an article titled “Detection of Delirium and Its Symptoms by Nurses Working in a Long Term Care Facility.” Because delirium is often difficult to recognize, the article studied the accuracy of nurses in diagnosing delirium in their patients. Although often associated with dementia, delirium distinguishes itself from dementia because it is a disorder that is usually reversible, while dementia is a chronic illness that develops over a span of time. Delirium affects a patient’s attention span, consciousness levels, and overall cognitive abilities. Patients typically experience disorientation, memory loss, difficulty with perception, agitation, and a disrupted sleep cycle.
While delirium can be caused by infections, such as sepsis, some other causes of delirium, according to the article, include dehydration, medications, and the use of a physical restraint. Previous studies have also cited chemical restraints as a significant factor that contributes to the development of delirium. Some commonly used chemical restraints are antipsychotic drugs, which effectively sedate and restrain patients, but have many extremely serious side effects, including delirium.
The key to finding a suitable nursing home for your loved one requires close observation of both the quality and quantity of the facility’s staff. With proper staffing levels, dehydration, among many other health issues, is avoidable. Therefore, if a nursing home has blamed your loved one’s delirium on dehydration, the facility is ultimately at fault for failing to prevent dehydration in the first place. The use of restraints, both chemical and physical, is often another consequence of understaffing. When nurses are preoccupied with so many other patients, they may find it difficult to provide each patient with the individualized care that he or she needs and resort to the use of restraints.
With respect the issue of quality of staffing, the study results showed that nurses recorded more cases of delirium than there actually were. Although treatments for delirium may not actually be harmful to patients who do not actually suffer from it, the results still reveal the poor training programs that facilities often provide to their nurses.
Beyond this specific case that studied accuracy in identifying cases of delirium, the study has further implications that nurses may be inaccurately diagnosing other medical problems, while some may be failing to do so at all. Sometimes in skilled nursing facilities, employees are actually directed to improperly document and diagnose illnesses, in a practice known as “downcoding,” to avoid liability and injury claims against them. Other facilities “upcode” in order to maximize reimbursement claims from government health agencies. We would like to increase your awareness of the manipulation of medical records that occurs in skilled nursing facilities. If you are ever in doubt of the accuracy of your loved one’s medical records, it is best for you to monitor his or her records and physical health yourself, or get a second opinion.
Although the staff at nursing home in which the study was conducted mistakenly overestimated the cases of delirium at their facility, other facilities may be underestimating the number of their patients who suffer from delirium. If the nursing home is failing to recognize that your loved is suffering from delirium, he or she is not receiving proper treatment for it. The study emphasizes the importance of recognizing the onset of delirium early so that the cause can be identified and the problem can be treated immediately, before progressing and worsening. If your loved one’s nursing home is failing to provide your loved one with proper care, he or she is a victim of elder abuse and nursing home neglect.