Jun 22, 2021
"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