Transient confusion, inattention in elderly sometimes due to dehydration, constipation — Expert

A psychiatrist, Dr Akin Ojagbemi, has stressed the importance of elderly people eating plenty of roughage and drinking water in preventing transient confusion, inattention, or altered states of consciousness sometimes caused by dehydration, constipation, and side effects of drugs.

Dr Ojagbemi, who spoke on delirium at the 8th edition of the Basic Certificate Course in Geriatric Medicine by the Chief Tony Anenih Geriatric Centre at the University College Hospital, Ibadan, declared that transient confusion or inattention, which is sometimes suggestive of delirium in elderly people, is a risk factor for dementia.

According to her, people with delirium have four times the risk of developing dementia and also four times the risk of dying in one year of delirium compared to those without delirium.

He said although the exact mechanism of delirium is currently unknown, its risk factors for delirium are multifactorial, but its triggers could include treatment given to patients, medications, electrolyte imbalance, surgical procedures, dehydration, constipation, and anaesthesia.

“They might have a painful experience that they are unable to articulate. And because of that fact, they become agitated and delirious. But we often focus on the primary reason why the patient was admitted, without also looking at the possibility that some of our treatment, including antidepressants, could have triggered something like delirium in the patient,” he added.

For its prevention, Dr Ojagbemi suggested ensuring appropriate lighting levels for elderly patients, reorientation of the elderly, encouraging their mobility, social activity, hydration, good night sleep, and avoidance of things that could trigger a derailment.

“For some patients, it might just be sensory impairments. Maybe they were wearing spectacles at home before they came to the hospital, and then they don’t have their glasses with them in the hospital, and then they become disorientated,” he added.

Dr Femi Olowokere, a family physician and geriatrician, stated that delirium is not recognised in 80% of people affected because many health care practitioners do not know how to make its diagnosis.

According to him, “If somebody has hypoactive delirium and is unrecognised, that patient can die. That is why older people are better treated in hospitals because many things can precipitate it, including constipation, pain, urinary tract infection, and dehydration.”

Director of the Chief Tony Anenih Geriatric Centre at the University College Hospital (UCH), Dr. Lawrence Adebusoye stated that the training was to build capacity of health workers to respond to the need of increasing the older population in Nigeria.

“There’s a difference between a normal ageing process and a disease process. As a healthcare practitioner, you should know if the particular change seen in an older person is due to the natural ageing process or if it is a disease process.

“Most often, about one-third of the problems in older people are caused by healthcare workers intervening wrongly, with the wrong measure at the wrong time. So knowledge is of paramount importance.”

In a remark, Mr. Tunde Ajobo, a clinical dietitian and president of the Institute for Dietetics in Nigeria, Oyo State branch, said older people urged increased water, fruit, and vegetable intake and exercises to prevent constipation and dehydration.

“We encourage them to drink the water; it can be flavoured with Vitamin C; to take ewedu or okra with their food; they can drink it also. That way, it will boost the fibre intake. When they sit down too long on the seat, it can lead to constipation. So, mere walking within the compound can help to stimulate bowel movement, too.”

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