I want to share a story that illustrates an important lesson I’ve learned about sudden change, especially in the elderly. Take a look at this picture of an older man. This man represents the patients I first encountered when I finished my internal medicine residency in 1986 and started my geriatric medicine rotation at the local Veteran’s Administration hospital.
Back then, I’d often get called to the emergency room to assess elderly patients in distress. I’d walk in and find them confused, barely responsive, and completely disoriented. My first instinct was to think about finding them a good nursing home, but my training steered me in a different direction.
I took the time to dig deeper – ask questions of patient and family, review their health and living history, and run tests. And what I discovered was surprising. Time and again, just days before, these patients were living independently. They were driving, meeting friends for breakfast at McDonald’s, golfing on weekends, and even babysitting their grandkids. So, what had happened?
After thorough evaluation, I found that these patients weren’t suffering from dementia or Alzheimer’s disease. Instead, they were experiencing delirium – a sudden confusion brought on by an underlying medical issue, like pneumonia, a severe urinary infection that had spread throughout their body, or adverse reactions to a new medication.
Once we treated the root cause – whether with antibiotics or by stopping the offending medication – these patients often recovered in a matter of days or weeks. They were able to go home, return to their usual activities, and feel like themselves again.
This experience taught me a valuable lesson: sudden changes don’t come out of nowhere. Alzheimer’s doesn’t set in overnight. Often, the confusion we see in the elderly is a result of something treatable. Sudden problems cause sudden changes, but they can also be resolved, allowing people to get back to their previous lives.