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IntroductionYou’re dispatched for “stomach pain.” The

patient is an 81-year old female, slumpedover on a living room couch, her face hiddenin the folds of the pillows. Her daughterstands nearby.

“Mrs. Johnson!” you call as you quicklypalpate her radial pulse. Her skin is flushed,dry and a bit warmer than normal.

After you and your partner sit her up, youask her, what’s wrong? “I can’t breathe,” shesays. Her pulse oximetry reading is 97%, herrespiratory rate is 16 bpm, her speech,halting.

You ask her if anything hurts. Whileyou’re questioning her she watches you

intently, but when you stop, her eyes wander.Moments pass and suddenly she notices youat her side. You ask again: “What’s wrong?”

“I’m sick,” the woman finally says faintly.She stares vacantly into the distance. Youcontinue your questioning but the woman’sanswers lack clarity.

Her daughter says she has been like thisfor two days, complaining of a stomachacheone moment, difficulty breathing at another.She eats and drinks little, is up all night andcatnaps during the day. Occasionally sheshouts something, but her words make nosense.

What’s going on? Your mind is as blankas the patient’s face.

How often are we called to a homeor nursing home to care for someonewho seems healthy, but is not makingsense? Or someone who cannot saywhy he called 911, but is obviously indistress? How often do we deliver anolder patient to the emergencydepartment not knowing what thechief complaint is other than “thepatient is not herselftoday,” i.e., altered? Eld-erly patients presentingwith altered mentalstatus are common inEMS practice.

Delirium takes onmany appearances, andeach guise can be anindicator of any numberof underlying condi-tions that may take daysin the hospital to clarify.For EMTs whose expo-sure time with thepatient is usually lim-

ited, awareness is key. EMTs shouldunderstand that a sudden change in anelderly person’s affect, e.g., consciousness,cognition and perception, is a serious com-plaint.

In patients who are admitted withdelirium, mortality rates are 10-26%.In patients who are elderly… delirium mayresult in a prolonged hospital stay, increasedcomplications, increased cost, and long-termdisability.

Plowing Off-CenterDelirium has an interesting, albeit,

cruel history. For many centuries,delirium was seen sometimes as asymptom and other times, a syn-drome – a highly lethal syndromewith a poor outcome for survivors.Most sufferers, many of them elderly,spent their lifetimes in “ insaneasylums,” tied to beds, lying naked onfrozen floors, hosed with cold water,given barbaric treatments and forgot-ten. [See Figure 1.] Not until the 20thcentury did it become evident that

Delirium In The Elderly by Julie Abergerby Julie Aberger

The Gold Cross CONTINUING EDUCATION SERIESThe Gold Cross CONTINUING EDUCATION SERIES

After reading this article, the EMT willbe able to:

• understand the medical implicationsof an acute onset of delirium in theelderly patient;

• know the signs and symptoms ofdelirium;

• list the conditions that predispose anelderly person to delirium;

• cite the range of medications thatcommonly induce delirium in theelderly patient;

• cite the range of brain insults that canproduce delirium in the elderly;

• list the differences between dementiaand acute delirium;

• discuss effective EMS managementtechniques in assessing, treating andtransporting an elderly patient withdelirium.

After reading this article, the EMT willbe able to:

• understand the medical implicationsof an acute onset of delirium in theelderly patient;

• know the signs and symptoms ofdelirium;

• list the conditions that predispose anelderly person to delirium;

• cite the range of medications thatcommonly induce delirium in theelderly patient;

• cite the range of brain insults that canproduce delirium in the elderly;

• list the differences between dementiaand acute delirium;

• discuss effective EMS managementtechniques in assessing, treating andtransporting an elderly patient withdelirium.

EMT ObjectivesEMT Objectives

Figure 1:

William Hogarth’s “Bedlam” - 1735William Hogarth’s “Bedlam” - 1735

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delirium was characterized by a fullrecovery among survivors, distinctfrom dementia. And that deliriumoften stemmed from a physiologicalcause – something wrong with thephysical body – not a psychologicalone.

The word delirium derives from anancient agricultural term used todescribe a faulty method of plowing,whereby the earth thrown up by aplow between two furrows lands off-center, causing the rows of plants tobe crooked. In the 16th century,however, the word took on the con-notation of “ I deviate from thestraight track,” and subsequently, “I’mno longer in my right mind.”

Today delirium is recognized as asymptom/sign, or manifestation, ofacute illness that has many causes. Inthis article we will examine some ofthe more common causes of deliriumin the elderly patient, causes thatdisturb a person’s affect, or his feelingor emotion, especially as manifestedby facial expression or body lan-guage.

Frickin’ Nuts!As we have stated, delirium is an

alteration in a person’s consciousness,cognition and perception. These dis-turbances usually occur over hours-to-days. The condition may appearsuddenly, or may present over severaldays with mild symptoms such as dif-ficulty sleeping, anxiety, agitation,inattentiveness, and short-termmemory loss.

Signs and symptoms of suddenonset of delirium include:

• Changes in attention: The patientis unable to focus; his mind wanders.

• Changes in cognition: The patientis no longer oriented to person, place,or time. Or the patient has suddenlapses in memory that are unusual.

• Changes in perception: Thepatient has delusions or hallucina-tions. A delusion is a misbelief in whatis generally accepted as reality, forexample, a fantasy or illusion.

A hallucination is also an illusion,but one that stimulates the senses.The patient perceives – sees, hears,smells, feels, etc. – something that isnot present, e.g., the patient hears apack of wild dogs barking outside herdoor, or feels bugs crawling over hisbody.

Delirium comes in a range ofbehaviors. The delirious patient maybe passive, hyperactive, depressed oraggressive. Your patient may besleepy, crying, raving, harming him-self or others. He may be cursing andconfused at home yet speak and actlike a gentleman at the hospital. Thespectrum of behaviors fluctuates withtime.

How do EMTs often react whenconfronted with such a patient? “He’sfrickin’ nuts!”

Think again.

Why Does Delirium OccurCommonly in the Elderly?

Conditions that predispose theelderly to delirium include: the agedbody and brain, poor homeostaticregulation, and impaired vision andhearing. Drugs often have deleteriouseffects, causing more harm than good.

As we age, the brain loses its resil-iency to withstand trauma and/orinfection, because of changes in cere-bral biochemical activity affecting thecerebral cortex, the outer layer of thebrain. This section of the brain plays akey role in memory, attention, per-ception, cognition, awareness,thought, language and consciousness.Directly under the cerebral cortex,the subcortical structures that enablefast, unconscious motor reactions,such as reflexes, are negativelyaffected as well.

The brain controls the function ofthe body; its 100 billion neurons, ornerve cells, are designed to stimulatecorresponding cells into action.Everything we think or feel is a resultof these nerve cells communicatingwith each other, called neurotrans-mission. In the autonomic nervous

division of the peripheral nervoussystem, chemical messengers, calledneurotransmitters, send signals acrossnerve synapses, either inhibiting (bal-ancing mood, regulating sleep cycle)or stimulating (motivating) an action.More than 100 unique neurotrans-mitters have been identified,common ones being epinephrine,acetylcholine, histamine, serotonin,glutamate, and dopamine.

With age, the senescent brainbecomes less efficient, and neuro-transmission becomes sluggish.When neurotransmitters are notbeing synthesized (metabolized)properly, the imbalance commonlyproduces changes in arousal, alert-ness, attention, information process-ing, memory, and normal sleep-wakecycle. Homeostasis – the body ’sability to seek and maintain an inter-nal equilibrium – becomes a slipperyslope.

Pharmacopoeia:You are dispatched for an altered 74-year

old male on the third floor of an old citybuilding. As you carry your equipment upthe steep rickety steps, your crew struggleswith the litter behind you. When you openthe man’s apartment door, you are con-fronted with the smell of rancid food andurine. You see stacks of papers, empty cans,and bottles throughout the vast room.

“Ambulance here!” you yell, but are metwith silence. Then you hear a voice, “Allhands on deck! The ship is foundering!We’re going down!” The patient is foundnaked except for a Navy cap on his head,sitting on the floor near the window. As youaddress him, he stares straight ahead. Thenyou notice a table crowded with opened pillbottles. Hundreds of tablets are spilled overthe surface.

The elderly are more likely to havemultiple medical conditions and be

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CEU Article: Elderly Delirium-continued from page 10

Delirium is recognized as a symptom/sign, or

manifestation, of acute illness that has

many causes.

Delirium is recognized as a symptom/sign, or

manifestation, of acute illness that has

many causes.

Everything we think or feel is a result of

our 100 billion neurons communicating with

each other, called neurotransmission.

Everything we think or feel is a result of

our 100 billion neurons communicating with

each other, called neurotransmission.

-continues on page 12

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taking numerous prescribed andover-the-counter medications. It iscommon, however, that they are notaware of the drugs, their actions andtheir dosages. (When asked aboutmeds, how often do EMTs hearpatients say: “It’s a little blue pill.”?)Stories abound of EMS handing overthe patient at the hospital with a bagcrammed full of meds, some expired,others without labels.

Persons aged 65 years and oldercomprise only 13% of the population,yet account for more than one-third

of total outpatient spending on pre-scription medications in the UnitedStates. Pharmacopoeia, or multipledrug use, creates significant problemsfor an age group that is often ill-equipped to handle the physiologicalassault.

As we have said, prescribed, over-the-counter and illicit drugs arecommon causes of delirium amongthe elderly, accounting for 22%-39% ofcases. Why is this?

• The aged body metabolizes at aslower rate, toxicity becomes aproblem and the elderly patient maysuffer harmful side effects.

• Cognitive decline can contributeto the misapplication of drugs.

• Impaired vision and hearing canlead to accidental under- or overdose.

• A large number of older adultsuse over-the-counter meds anddietary supplements which can alter aprescribed drug’s intended action.

• Inappropriate use: Who hasn’theard of the husband taking the wife’smedications, because he had “runout” of a medication, or to savemoney?

• Socioeconomics: From theNational Council on Aging: Over 25million Americans aged 60+ are economi-cally insecure—living at or below 250% ofthe federal poverty level (FPL, which is cur-rently $29,425 per year for a single person).These older adults struggle with risinghousing and health care bills… Someseniors may not be taking their pre-scribed medications simply becausethey can’t afford it.

Delirium may stop quickly when anew drug is discontinued. Conversely,abrupt discontinuation of a drug canalso cause delirium. Overdose, with-drawal, or adverse reactions to drugs,may cause a sudden onset of deliriumas well.

Drugs that commonly provokedelirium in the elderly include: lev-odopa, (Laradopa®) for Parkinson’sDisease; meperidine, Ambien® forsedative/hypnotic effects; ranitidine,(Zantac®) for GI reflux; Benadryl® anantihistamine; warfarin, Eliquis®,anticoagulants for stroke, heart attackprevention; digoxin, (Lanoxin®) forheart failure or A-Fib; diltiazem(Cardizem®) for hypertension and

angina; theophylline, (Uniphyl®) forCOPD and asthma; ciprofloxacin,(Cipro®) antibiotics, and many, manyothers.

Therefore, a complete patienthistory and a list of medications arevital to the ER physician when deal-ing with a change in affect . Butrealize, the list of drugs that canproduce delirium is legion.

Trauma/Cerebral InsultYour elderly neighbor calls you for help.

His spouse has run out into the road and col-lapsed. You call 911, then go outside to findthe old woman sprawled on the street, herarms and legs akimbo, a terrified look on herface. She is stuporous, not responding to anyof your questions. Her spouse tells you thatshe had suddenly begun yelling “Don’t hurtme! NO! NO!” and fled the house. Later atthe hospital, an MRI reveals a subduralhematoma, a venous brain bleed. Thepatient’s husband then recalled his elderlywife had fallen a week before and hit herhead. At the time, his wife thought it ‘just agoose egg.’

No matter what the age, any struc-tural “insult” can produce delirium,i.e., patients with a history of headtrauma or CNS infection. Stroke(CVA) and transient ischemic attack(TIA) can also cause an abrupt changein affect resulting in delirium. A headcomputed tomography (CT) scan ormagnetic resonance imaging (MRI)scan is needed to rule out any neo-plasms (abnormal growths of tissue),brainstem lesions, closed headinjuries, cerebral bleeds or clots. Alumbar puncture is also used todetect infection, i.e., inflammation ofthe brain caused by infection or aller-gic reaction such as meningitis. Yourranting/raving patient may have suf-fered brain trauma or infection.History is all-important here.

CEU Article: Elderly Delirium-continued from page 11

Stroke (CVA) and tran-sient ischemic attack

(TIA) can also cause anabrupt change in affect

resulting in delirium.

Stroke (CVA) and tran-sient ischemic attack

(TIA) can also cause anabrupt change in affect

resulting in delirium.

Asked At Convention:

What is the biggestor toughest problemyour squad is nowfacing?

“Attracting qualitymembers account-able for more thanjust resumé-build-ing; convincingthem that a profi-cient EMT is morethan just a BasicCourse. It takesyears of experi-ence and continu-ous education todeliver excellentpatient care.”

Barbara Nelson Mendham FAS

“Staffing andscheduling.”Carrie NilerLincoln Park EMS

“Manpower, specif-ically daytime cov-erage. We areworking on somefixes.”

Eric RuddBelvidere AC

“Getting existingmembers tobecome moreactive. Thisincludes new aswell as experi-enced members.”

Scott Maynard Livingston FAS

-continues on page 13

AlcoholYou are called for a “sick person” at an

affluent home of an older woman, renownfor her philanthropy. The maid who ushersyou in tells you “Mrs. Royce is a wee bitunder the weather today.” She also tells youthat her employer “likes her martinis” buthasn’t drunk any alcohol for two days.“She’s given them up for Lent,” the maidexplains.

You enter the w oman’s bedroom, butthere’s no one there. You call, “Mrs. Royce!”There is no response. Searching the room,you find the 80-year old lady in her night-gown, on the floor under the bed. She says“poisonous ants were crawling over her.” Herface is covered with deep-red scratch marks.You note her slurred speech and tremors.After much persuasion, you convince thewoman to go to the hospital “to get medicineto rid her of the ants.” As you leave the housewith the patient on the litter, you cross pathswith a young deliveryman shouldering a fullcase of high-priced vodka into the house. Thelocal cop accompanying you tells the kid toget lost.

There are 2.5 million older adultswith an alcohol or drug problem.Alcoholism has no social boundaries:It affects people of all incomes andages. Alcohol can become a habitual“friend” to the impoverished old manwho lives alone or to the wealthyscion of society surrounded byluxury.

Alcohol is a neurotoxin thatdamages the brain in a complexmanner through prolonged exposureand repeated withdrawal, resulting insignificant illness and death. Alcohol-related psychosis is often an indica-tion of chronic alcoholism and itswithdrawal causes a full spectrum ofsymptoms ranging from mild anxietyto full-blown delirium tremens (DTs)with agitation and seizures. Suddendiscontinuation of alcohol for thealcoholic can be fatal. Always checkthe altered patient’s history for ETOHuse, chronic or acute. Look for signsof alcoholism such as the smell ofalcohol, anxiety, agitation, hyperten-sion, diaphoresis, flushed skin, dis-tended abdomen and broken capillar-ies on the face and nose.

InfectionYou are called for “altered mental

status.”While gathering your patient’shistory, a family member tells you that their68-year old father had always been in goodhealth until he had a routine biopsy forprostate problems a day earlier. The next

day he became confused and withdrawn. Hethen began saying nonsensical things, andwhispering to old friends from his childhood.He also complained of chills and achingmuscles. His orientation was not completelyaltered, but his “wandering mind” was theonly clue the family had that somethingserious w as wrong. You note that thepatient’s skin is warmer than normal, dryand very pale. By the time you reach the hos-pital, the patient is obtunded, i.e., he is con-scious, but not reacting to any verbal stimuli.At the ED, the physician begins emergencytreatment for sepsis. The patient dies severaldays later.

Infections, especially of the urinarytract and pneumonia, are anothercommon cause of delirium. As amatter of fact, sometimes the only

symptom an elderly patient has of aninfection is delirium! She’ll presentwith severe confusion before any evi-dence of fever, tachycardia and/orpain.

One of the markers of sepsis –massive systemic infection – is delir-ium. Sepsis is commonly due to bac-terial and fungal infections, as well asnoninfectious causes, such as pancre-atitis or trauma. Infections can stemfrom indwelling IVs and catheters toinvasive procedures, like biopsies.Sepsis syndrome is the systemicresponse triggered by an infectionthat is met with an activated inflam-matory cascade within the body. Theorganism is overwhelmed, resultingin a whole host of signs and symp-toms. Delirium may be the leastsubtle clue.

OpioidsYou are called for “sick person.” The 68-

year old man had been sent home from thehospital two days previous after having hadsurgery placing a metal rod and screws in hisfemur for a “broken hip.” The daughter tellsyou her father has not spoken to her in 24hours.

As you enter the room, you see the mansitting up in bed with a breakfast table overhis lap. On it is a cup of thick soup. As yourpartner takes notes from the daughter, youaddress the man, asking him what hurts.The man remains silent and does not look atyou. Slowly he tips the cup of soup onto thetable. With his finger, he writes F B I in itand nods towards his daughter. He then putshis finger to his lips and whispers: “Shhh.”

Before surgery the anesthesiologisthad administered a benzodiazepineto this patient to relax him. During

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CEU Article: Elderly Delirium-continued from page 12

-continues on page 14

Alcohol-related psychosis is often anindication of chronicalcoholism and its

withdrawal causes a fullspectrum of symptoms

ranging from mildanxiety to full-blown

delirium tremens (DTs) with agitation

and seizures.

Alcohol-related psychosis is often anindication of chronicalcoholism and its

withdrawal causes a fullspectrum of symptoms

ranging from mildanxiety to full-blown

delirium tremens (DTs) with agitation

and seizures.

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surgery he was given propofol as ageneral anesthesia, and in the recov-ery room, he received morphinesulfate for pain relief. One surgeondescribed the man’s altered mentalstate as “post-operative,” and that thedelirium would disappear as soon asthe narcotics cleared his system. Theopioids, such as fentanyl, morphinesulfate, and oxycodone, can causedelirium in the elderly patient before,during and after surgery. Trans-formations are sudden and dramatic:Your sweet mother who never uttereda bad word in her life may be cursinglike a truck driver. Fortunately, theseeffects are usually shortlived.

Electrolyte AbnormalitiesDeficiencies of certain electrolytes,

e.g., minerals and vitamins, can alsocause delirium. Too little sodium, toomuch potassium, dehydration, fluidimbalance, and malnutrition are but afew of the dietary imbalances that canimpact the elderly patient’s affect andimpair his behavior. When alco-holism causes a deficiency of VitaminB12, an alcoholic will suffer delirium.

Poor nutrition, bad diet, GI prob-lems (beginning with poor dental careand decreased saliva production), anddiabetes, all common to the elderly,can produce deficiencies in normalmetabolism. Other deficiencies in thebloodstream include, for instance,hypernatremia and hyponatremia(too much-too little salt), hypercal-cemia (too much calcium), hypomag-nesemia-hypermagnesemia (toolittle-too much magnesium) – and allcan cause delirium. Organ failuresuch as congestive heart failure,kidney, liver insufficiency, andendocrine deficiencies – all commonamong the elderly – can also be cul-prits in this loss of affect called delir-ium.

Heat & ColdYou are called to the local sportsman’s

club for “man vomiting.” As you enter thekitchen of the club, you are directed to“Bubba,” a 72-year old overweight man,dressed in shorts and a teeshirt sitting on astool near the stove, looking vacant. Pools ofvomit are on the floor at his feet. He is bab-bling and makes no sense. Even though it is90 degrees outside and at least 100 insidethe kitchen, his skin is dry and hot. Hispulse is 156 bpm, his blood pressure is96/54, and his respiratory rate is fast andshallow.

His friends tell you Bubba had beencooking dogs and kraut all morning for thatafternoon’s picnic. Then he tried a couple ofbeers “ to cool off.” Bubba is now trying torecite the Gettysburg Address.

Heat and cold emergencies com-monly alter an elderly person’s affect;the brain reacts badly to temperaturechanges. Hyperthermia has a directeffect on the central nervous system,raising the brain’s temperature, alter-ing its blood flow, cognitive function,neurotransmissions and neuromus-cular activity.

The elderly don’t require Arctictemperatures to become hypother-mic. A lot depends on a person’s age,body mass, body fat, overall health,and length of time exposed to coldtemperatures. A frail, older adult in a60-degree house can develop mildhypothermia overnight . Certainmedical conditions such as hypothy-roidism and diabetes, some medica-tions, severe trauma, use of drugs

and/or alcohol, all increase the risk ofhypothermia that in turn raises thepossibility of mental changes.

Low body temperature slows brainactivity. Normal body temperatureaverages 98.6 degrees. With hypo-thermia, core temperature dropsbelow 95 degrees. In severe hypo-thermia, core body temperature candrop to 82 degrees or lower. Yourhypothermic elderly patient mayhave memory loss, be slow to speakand/or move, shiver, or slur hiswords. He may be uncoordinated,stumbling and falling. (You maywonder: “Alcohol?”) His home may beunderheated or overheated and hemay be wearing multiple layers tokeep warm.

Delirium Vs DementiaDelirium is also a feature of demen-

tia, and it is often difficult to differen-tiate the two. Is the patient deliriousdue to one of many physiologiccauses, or is it dementia, a progressivedisease that usually involves a longerperiod of time, often years? [See Table1, below]

The prevalence of dementia in theUnited States today is about 1% at age60, but doubles every 5 years until itreaches 30% to 50% by 85 years of age.By 2030 it is estimated that there willbe approximately 10 million peoplewith Alzheimer’s dementia in the U.S.

What is dementia and how does itdiffer from delirium?

CEU Article: Elderly Delirium-continued from page 13

Heat and cold emergen-cies commonly alter anelderly person’s affect;

the brain reacts badly totemperature changes.

Heat and cold emergen-cies commonly alter anelderly person’s affect;

the brain reacts badly totemperature changes.

-continues on page 15

Feature

Onset

Course

Duration

Consciousness

Attention

Psychomotor Changes

Reversibility

Delirium

acute

fluctuating

days to weeks

altered

impaired

increased & decreased

usually

Dementia

insidious

progressive

months to years

clear

normal

often normal

rarely

(except in severe dementia)

Table 1:

Differentiating Features of Delirium and DementiaDifferentiating Features of Delirium and Dementia

Dementia is a broad term used todescribe more than 50 differentdisease states primarily Alzheimer’sdisease, which involves atrophy(wasting) of the grey and white matterof the brain. The presence of demen-tia increases the risk of delirium two-to-three times.

Typically dementia has a gradualonset that develops over months ifnot years, with little change in day-to-day or even week-to-week behavior.Dementia victims are usually theelderly. Their vital signs are normalunless they are ill.

EMS CareDelirium is a medical emergency.

As always, during our primary assess-ment , we assess and manage thepatient’s A-B-Cs, treating any anoma-lies as they arise.

• Is the patient hypoxic? What isher pulse oximetry? B elow 93%,provide supplemental oxygen.

• Is the patient diabetic? Ask thefamily or caregiver. If the patient isexhibiting signs and symptoms ofhypoglycemia, and can swallow, giveoral glutose.

• Has the patient taken an overdoseof opioids? If so, administer Narcan®.

• Does the patient have a history ofalcoholism? Has the patient ingested atoxic substance, either intentionallyor accidentally? How about carbonmonoxide poisoning?

• Medical history: Illness? Trauma?Procedures? Hospitalizations? Allessential information.

• Medications? Prescribed, over-the-counter, homeopathic?

• Socioeconomics: Is the patientliving in poverty? Is there food in therefrigerator? Is there heat and air con-ditioning? Hypo- and hyperthermicpatients may be delirious. Passiverewarming is indicated for hypother-mia; passive cooling for hyperthermicpatients.

Supportive Treatment:• Do not overwhelm the delirious

patient . Speak slowly and, if thepatient has no hearing problems,softly. Turn down (or off) the extra-

neous radio chatter. Keep on-scenepersonnel to a minimum. Andthere’s no reason for lights-and-sirens unless it’s a life threateningillness or injury.

Make certain you have the patient’seyeglasses, hearing aids, cane orwalker with him to go to the hospital.A list of current medications (dosage,route and time) is essential.

You must protect your patient fromharming himself or others while inyour care. Restraints may be needed,but first seek the patient’s coopera-tion with gentle words and actions.Physical restraints may increase hisagitation, risking injury to yourselfand him. (Physical restraints in agi-tated patients have been associatedwith significant injuries and evendeath by asphyxiation and should beused sparingly. Squads should periodi-cally review their SOPs on the use ofrestraints.)

It is essential that if the patient hasno family or friends, caregivers orsupport, that you be his advocate.This means assuring him that he isbeing taken to “a safe place,” theproper facility with caring, competentnurses and doctors, who will supporthim emotionally as well as medically.Hospitals should not be viewed asdumping grounds for the emotionallyunstable elderly person who might behomeless or indigent due to life cir-cumstances.

Remember: When you deal withelderly patients who are exhibitingbizarre behavior, “Do No Harm” alsomeans “Do the Right Thing.” Theseunfortunate persons are vulnerableto mistreatment and should be pro-tected at all cost.

Julie Aberger is an EMT instructor andan active member of the Pennington FirstAid Squad. Julie is also the editor emeritaof The Gold Cross.

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CEU Article: Elderly Delirium-continued from page 14

Do not overwhelm the delirious patient.

Speak slowly and, if thepatient has no hearing

problems, softly.

Do not overwhelm the delirious patient.

Speak slowly and, if thepatient has no hearing

problems, softly.

The Gold Cross Magazine name and Logo, and the EMSCNJ/NJSFAC name and Logo, are the property of the New Jersey State First Aid Council. Articles from the Gold Cross Magazine reproduced on this Website are the property of Leonard Publications. None of such articles or any part thereof shall be reproduced, duplicated, copied, sold, resold, or otherwise exploited for any commercial purpose without the prior written consent.