Pop quiz: What aging health problem is extremely common, has serious implications for an older person’s health and wellbeing, and can often – but not always – be prevented?
It’s delirium. In my opinion, this is one of the most important aging health problems for older adults to be aware of. It’s also vital for family caregivers to know about this condition, since families can be integral to preventing and detecting delirium.
In this article, I’ll explain just what delirium is, and how it compares to dementia. Then I’ll share 10 things you should know, and what you can do.
What is Delirium
Delirium is a state of worse-than-usual mental confusion, brought on by some type of unusual stress on the body or mind. It’s sometimes referred to as an “acute confusional state,” because it develops fairly quickly (e.g., over hours to days), whereas mental confusion due to Alzheimer’s or another dementia usually develops over a long time.
The key symptom of delirium is that the person develops difficulty focusing or paying attention. Delirium also often causes a variety of other cognitive symptoms, such as memory problems, language problems, disorientation, or even vivid hallucinations. In most cases, the symptoms “fluctuate,” with the person appearing better at certain times and worse at other times, especially later in the day.
Delirium is usually triggered by a medical illness, or by the stress of hospitalization, especially if the hospitalization includes surgery and anesthesia. However, in people who have especially vulnerable brains (such as those with Alzheimer’s or another dementia), delirium can be provoked by medication side-effects or less severe illnesses.
It’s much more common than many people realize: about 30% of older adults experience delirium at some point during a hospitalization.
That confusion after surgery that older adults often experience? That’s delirium.
The way your elderly mother with dementia gets twice as confused when she has a urinary tract infection? That’s delirium too.
Or the common phenomenon of “ICU psychosis”? That too is delirium.
What Causes Delirium?
In older adults, delirium often has multiple causes and contributors. These can include:
- Infection (including UTI, pneumonia, the flu, COVID)
- Other serious medical illness (e.g. heart attack, kidney failure, stroke, and more)
- Metabolic imbalances (e.g. abnormal blood levels of sodium, calcium, or other electrolytes)
- Dehydration
- Medication side-effects
- Sleep deprivation
- Uncontrolled pain
- Sensory impairment (e.g. poor vision and hearing, which can worsen if the person is lacking their usual glasses or hearing aids)
- Alcohol withdrawal
Delirium vs. Dementia
People often confuse delirium and dementia (such as Alzheimer’s disease), because both conditions cause confusion and appear superficially similar. Furthermore, people with dementia are actually quite prone to develop delirium. That’s because delirium is basically a reflection of the brain going haywire when it gets overloaded by the stress of illness or toxins, and brains with dementia get overloaded more easily.
In fact, the more vulnerable a person’s brain is, the less it takes to tip them into delirium. So a younger person generally has to be very very sick to become delirious. But a frail older person with Alzheimer’s might become delirious just from being stressed and sleep-deprived while in the hospital.
Why Delirium is Such an Important Problem
There are three major reasons why delirium is an important problem for us all to prevent, detect, and manage.
First, delirium is a sign of illness or stress on the body and mind. So if a person becomes delirious, it’s important to identify the underlying problems – such as an infection or untreated pain – and correct them, so that the person can heal and improve.
The second reason delirium is important is that a confused person is at higher risk for falls and injuries during the period of delirium.
The third reason is that delirium often causes serious consequences related to health and well-being.
In the short-term, delirium increases the length of hospital stays, and has been linked to a higher chance of dying during hospitalization. In the longer-term, delirium has been linked to worse health outcomes, such as declines in independence, and even acceleration of cognitive decline.
Now let’s cover 10 more important facts you should know about delirium, especially if you’re concerned about an aging parent or other older relative.
10 Things to Know About Delirium, and What You Can Do
1.Delirium is extremely common in aging adults.
Almost a third of adults aged 65 and older experience delirium at some point during a hospitalization, with delirium being even more common in the intensive care unit, where it’s been found to affect 70% of patients. Delirium is also common in rehabilitation units, with one study finding that 16% of patients were experiencing delirium.
Delirium is less common in the outpatient setting (e.g. home, assisted-living, or primary care office). But it still can occur when an older adults gets sick or is affected by medications, especially if the person has a dementia such as Alzheimer’s.
What to do: Learn about delirium, so that you can help your parent reduce the risk, get help quickly if needed, and better understand what to expect if your parent does develop delirium. You should be especially be prepared to spot delirium if your parent or loved one is hospitalized, or has a dementia diagnosis. Don’t assume this is a rare problem that probably won’t affect your family. For more on hospital delirium, see Hospital Delirium: What to know & do.
2. Delirium can make a person quieter.
Although people often think of delirium meaning as a state of agitation and or restlessness, many older delirious people get quieter instead. This is called hypoactive delirium. It’s still linked with difficulty focusing attention, fluctuating symptoms, and worse than usual thinking. It’s also linked with poor outcomes. But it’s of course harder for people to notice, since there’s little “raving” or restlessness to catch people’s attention.
What to do: Be alert to those signs of difficulty focusing and worse-than-usual confusion, even if your parent seems quiet and isn’t agitated. Tell the hospital staff if you think your parent may be having hypoactive delirium. In the hospital, it’s normal for older patients to be tired. It’s not normal for them to have a lot more difficulty than usual making sense of what you say to them.
3. Delirium is often missed by hospital staff.
Despite the fact that delirium is extremely common, it is often missed in hospitalized older adults, with some reports estimating it’s being missed 70% of the time. That’s because busy hospital staff will have trouble realizing that an older person’s confusion is new or worse-than-usual. This is especially true for people who either look quite old – in which case hospital staff may assume the person has Alzheimer’s – or have a diagnosis of dementia in their chart.
What to do: You must be prepared to speak up if you notice that your parent isn’t in his or her usual state of mind. Hypoactive delirium is especially easy for hospital staff to miss. Hospitals are trying to improve delirium prevention and detection, but we all benefit when families help out. Remember, no hospital person knows your parent the way that you do.
4. Delirium can be the only outward sign of a potentially life-threatening problem.
Although delirium can be brought on or worsened by “little things” such as sleep deprivation or untreated constipation, it can also be a sign of a very serious medical problem. For instance, older adults have been known to become delirious in response to urinary tract infections, pneumonia, and heart attacks.
In general, it tends to be older persons with dementia who are most likely to show delirium as the only outward symptom of a very serious medical illness. But whether or not your older relative has dementia, if you notice delirium, you’ll want to get a medical evaluation as soon as possible.
What to do: Again, if you notice new or worse-than-usual mental functioning, you must bring it up and get your parent medically evaluated without delay. For older adults who are at home or in assisted -living, you should call the primary care doctor’s office, so that a nurse or doctor can help you determine whether you need an urgent care visit versus an emergency room evaluation.
5. Delirium often has multiple underlying causes.
In older adults with delirium, we often end up identifying several problems that collectively might be overwhelming an older person’s mental resilience. Along with serious medical illnesses, common contributors/causes for delirium include medication side-effects (especially medications that are sedating or affect brain function), anesthesia, blood electrolyte imbalances, sleep deprivation, lack of hearing aids and glasses, and uncontrolled pain or constipation. Substance abuse or withdrawal can also provoke delirium.
What to do: To prevent delirium, learn about common contributors and try to avoid them or manage them proactively. For instance, if you have a choice regarding where to hospitalize your parent, some hospitals have “acute care for elders” units that try to minimize sleep deprivation and other hospital-related stressors. If your parent does develop delirium, realize that there is often not a single “smoking gun” when it comes to delirium. A good delirium evaluation will attempt to identify and correct as many factors as possible.
6. Delirium is diagnosed by clinical evaluation.
To diagnose delirium, a doctor first has to notice – or be alerted to – the fact that a person may not be in his or her usual state of mind. Experts recommend that doctors then use the Confusion Assessment Method (CAM), which describes four features that doctors must assess. Delirium can be diagnosed if a patient’s symptoms include “acute onset and fluctuating course,” “difficulty paying attention,” and then either “disorganized thinking” or “altered level of consciousness.”
Delirium cannot be diagnosed by lab tests or scans. However, if an older adult is diagnosed with delirium, doctors generally should order tests and review medications, in order to identify factors that have caused or worsened the delirium.
What to do: Again, the most important thing for you to do is to get help for your loved one if you notice worse-than-usual confusion or difficulty focusing. Although families have historically not had a major role in delirium diagnosis, delirium experts have developed a family version of the CAM (FAM-CAM), which is designed for non-clinicians and has been shown to help detect delirium.
7. Delirium is treated by identifying and reversing triggers, and providing supportive care.
Delirium treatment requires a care team to take a three-pronged approach.
- Health providers must identify and reverse the illness or problems provoking the delirium.
- They have to manage any agitation or restless behavior, which can be tricky since a fair number of sedating medications can worsen delirium.
- The safest approach is a reassuring presence (family is best, but hospitals sometimes also provide a “sitter”) to be with the person, plus improve the environment if possible (e.g. a room with a window and natural light).
- The once-popular practice of physically restraining agitated older adults has been shown to sometimes worsen delirium, and should be avoided if possible.
- The care team needs to provide general supportive care to help the brain and body recover.
What to do: The reassuring presence of family is often key to providing a supportive environment that promotes delirium recovery. You can also help by making sure your loved one has glasses and hearing aids, and by alerting the doctors if you notice pain or constipation. Ask the clinical team how you can assist, if restlessness or agitation are an issue. Bear in mind that physical restraints should be avoided, as there are generally safer ways to manage agitation in delirium.
8. It can take older adults a long time to fully recover from delirium.
Most people are noticeably better within a few days, once the delirium triggers have been addressed. But it can take weeks, or even months, for some aging adults to fully recover.
For instance, a study of older heart surgery patients found that delirium occurred in 46% of the patients. After 6 months, 40% of those who had developed delirium still hadn’t recovered to their pre-hospital cognitive abilities.
What to do: If your parent or someone you love is diagnosed with delirium, don’t be surprised if it takes quite a while for him or her to fully recover. It’s good to be prepared to offer extra help during this period of time. You can facilitate recovery by creating a restful recuperation environment that minimizes mental stress and promotes physical well-being.
9. Delirium has been associated with accelerated cognitive decline and with developing dementia.
This is unfortunate, but true, especially in people who already have Alzheimer’s or another type of dementia. A 2009 study found that in such persons, delirium during hospitalization is linked to a much faster cognitive decline in the following year. A 2012 study reached similar conclusions, estimating that cognition declined about twice as quickly after delirium in the hospital.
In older adults who don’t have dementia, studies have found that delirium increases the risk of later developing dementia.
What to do: Experts aren’t sure what can be done to counter this unfortunate consequence of delirium, other than to try to optimize brain well-being in general. (For this, I suggest avoiding risky medications, getting enough exercise and sleep, being socially and intellectually active, and avoiding future delirium if possible.)
The main thing to know is that delirium has serious consequences, so it’s often worth it for a family to be careful about surgery in an older person, and it’s good to learn about delirium prevention (see below).
10. Delirium is preventable, although not all cases can be prevented.
Experts estimate that delirium is preventable in about 40% of cases. Preventive strategies are meant to reduce stress and strain on an older person, and also try to minimize delirium triggers, such as uncontrolled pain or risky medications.
In the hospital setting, programs such as the Hospital Elder Life Program (HELP) for Prevention of Delirium have been shown to work. For ideas on how families can help, see this family tip sheet from the Hospital Elder Life Program. For instance, families can help reorient a relative in the hospital, ensure that glasses and hearing aids are available, and provide a reassuring presence to counter the stress of the hospital setting.
Less is known about preventing delirium in the home setting. However, since taking anticholinergic medications (such as sedating antihistamines) has been linked with hospitalizations for confusion, you can probably prevent delirium by learning to spot risky medications your parent might be taking.
What to do: To prevent hospital delirium, carefully weigh the risks and benefits before proceeding with elective surgery. If your parent must be hospitalized, choose a facility using the HELP program or with an Acute Care for Elders unit if possible. Be sure to read HELP’s tips for families on preventing hospital delirium.
Remember, delirium is common and can be the only outward sign of a serious medical problem.
By educating yourself and helping your older loved ones be proactive about prevention, you can reduce the chance of harm from this condition.
And if you do notice symptoms of delirium, make sure to tell the doctors! This will help your parent get the evaluation and treatment that he or she needs.
Useful Online Resources Related to Delirium
Here are links to some of the resources I reference in the article:
- A study (one of many) finding that delirium is linked to worse health outcomes in the elderly
- A study of older adults in the Intensive Care Unit, finding that 43.5% had hypoactive delirium
- An article finding that older patients do better when they are hospitalized in an “Acute Care for Elders” unit (a special hospital ward tailored towards protecting older adults from hospital complications; they are great!)
- An explanation of the Confusion Assessment Method, which experts recommend doctors use to diagnose delirium
- A description of the Family-CAM, which experts developed to help family caregivers detect delirium
- A study finding that delirium accelerates cognitive decline in Alzheimer’s; a follow-up study finding that people with dementia decline twice as quickly after having delirium (!) is here.
- Tips on how family caregivers can prevent delirium, from the Hospital Elder Life Program
Last but not least, for my previous posts on delirium:
- Delirium: How Caregivers Can Protect Alzheimer’s Patients
- Hospital Delirium: What to Know and Do
- How to Maintain Brain Health: the IOM Report on Cognitive Aging
If you have any additional questions regarding delirium, please post them below!
This article was first written by Dr. Kernisan in July 2015, and was reviewed and updated in August 2023.
JPP says
My husband recently was hospitalized for high blood pressure. They ran all kinds of tests and he is healthy. However, he seemed to all of a sudden be confused. He doesn’t know who I am. He recognizes pretty much everyone but he is not certain who I am.
He is 76 years old, never been sick and this is his first time in the hospital. We have been married 53 years. What could this be?
Leslie Kernisan, MD MPH says
Sorry to hear of this problem, it must be distressing to suddenly not be recognized by a long-time spouse.
Such sudden confusion could be delirium, but it’s also possible that it could be something else affecting his brain. I would recommend asking his doctors for more information and help evaluating him. You might also want to consider a consultation with neurology. good luck!
Greg Tomlin says
My 85 year old father developed an infected toe. After many visits to various doctors, it was determined his leg had poor circulation and his foot had very little blood flow (no pulse).
During the procedure to insert a stent at the hip, the sedative Versed caused my father to become very combative, a side effect seen previously. We have no idea why Versed was used again. The procedure could not be completed.
For a few days he was somewhat confused but okay, and then he fell getting up from the couch.
After that he was very combative, restless, and stopped sleeping nearly completely. He spent a week in the hospital getting somewhat stabilized and then was sent to my sister’s, along with our mom. he was there for two weeks, displaying sundowners with worse and better days. Again no sleeping. After appearing to be improving, he had to return to the hospital after becoming very combative and agitated. At the hospital he broke his shoulder jumping out of bed, while his toes began to die.
The psych ward dosed him into nearly total unconsciousness and at that point he had a successful vascular bypass, then the toes were removed. A bout of sepsis followed but it responded to antibiotics.
He has never really awaken since he was drugged unconscious. The foot is healing but now he doesn’t even swallow and needs his mouth suctioned. All medications are being stopped, aside from antibiotics and minor pain medication.
Prior to this, my father could mow the grass, did his income taxes for 2018, and did the shopping for himself and mom.
Could this have started from from Versed? It’s been about 2 months since it began, and though he had some totally normal moments, he has been mumbling and mostly sleeping the last week.
No one at the hospital seems to know whats wrong with him. Brain shows no damage but his circulatory system is calcified heavily.
The only hope now is that after the leg fully heals, he will return to normal.
I share this mainly to warn others that Versed is not the best sedative for elderly patients.
Thank you.
Leslie Kernisan, MD MPH says
Sorry for delayed response and thank you for sharing your story.
Versed is a benzodiazepine used for sedation during procedures. All benzodiazepines are considered risky in older adults and can cause confusion or even paradoxical agitation in some older adults. In other older adults, they cause sedation and decrease agitation.
I don’t know whether I’d attribute his mental decline entirely to Versed. Probably his brain was vulnerable to begin with, and then the combination of infection, hospital/surgery stress, and sedatives tipped him into delirium and further cognitive decline.
I hope he improves once his leg heals. Good luck and take care!
Susan says
My 85 year old father, who we recently moved into a highly rated and very nice assisted living facility, has been battling congestive heart failure (after a serious heart attack 5 years ago) along with kidney failure stemming from the chf. His short-term memory has been slowly declining.
Yesterday, my brother called him, and for about 10 minutes, our usually subdued father chatted on and on about currently being on a ship out at sea that had been hijacked by pirates. After they ended the call and my brother called to tell me about it, I called my dad.
He greeted me enthusiastically, immediately letting me know that he was “on a ship out at sea that had been taken over by pirates”, but he “got lucky and saved the day when the head pirate turned his back” on him, so Dad was able to hit the pirate over the head.
He told me he was in the Pacific when I asked him which sea he was in. He provided details such as he had a gun, but so did the pirates, and during our surreal conversation, Dad shot at them. He couldn’t remember how he ended up on this hijacked ship, but remembered he’d been on board since that morning. He remarked that the pirates, who were now captaining the ship “had no idea what they were doing;” that he had been “extremely lucky,” and agreed with me that this was an amazing adventure!
Although he had a lot of laughter in his voice while describing this current event, he said it wasn’t that much fun. Before he ended the call, I told him to please be careful. Being serious, he promised that he would be very careful.
His cognitive decline over the past several months has been at the worst forgetting what he ate for dinner, or if my brother had visited him earlier that day.
Typically, our telephone conversations lately have been brief and very basic. He hasn’t been very talkative at all, with either my brother or me.
That’s another reason why the pirate conversation was so weird: besides the content, he was energetic, laughing, animated, happy to answer questions, and instead of the usual 3 minute mostly one-sided conversation, these two calls lasted 20 minutes with him doing most of the talking.
What was this? My brother left a message for the nurse but hasn’t heard anything back yet.
Leslie Kernisan, MD MPH says
Hm, interesting story.
Hard to say just what caused this, or how worried you should be. Usually, a sudden change in thinking or mental abilities is for the worse; this one sounds like an odd combination of “better” in that your father had more energy and animation and verbal output, but potentially “worse” in that he is telling an odd uncharacteristic story, which might reflect more confusion than usual.
One does hear about people with dementia having a random “perked up” moment every now and then like this…the brain and body are mysterious, we don’t understand everything that happens.
I hope he at least continues to be in good spirits. If you are worried about possible delirium, you could ask to have him further evaluated, or at least monitored a little more closely for the next few days. good luck!
Zoe Barrington says
This really resonated with me as my 80 year old father is currently in hospital and as he has Multiple System Atrophy, has a vulnerable brain and also being in the spectrum, finds the sensory overload if hospital traumatic.
He told us very calmly that the night before, mercenaries had stormed the ward, lined everyone up and then ordered them all to bed … he was surprised it had not been on the news! He does like to read books along the lines of Jack Reacher so I am wondering if reality and fiction have become blurred in his confused mind. It is very distressing so thank you for such a clear article
Nicole Didyk, MD says
Witnessing the effects of delirium in a family member can be so frightening and even heartbreaking.
Check out this article about Hospital Delirium and see the section on the Hospital Elder Life Program (HELP): /hospital-delirium-what-to-do/. If your dad isn’t enrolled in the program, I would request that, if he qualifies (in some cases, a person is too delirious or ill to participate).
Most times delirium improves, and it can be frustrating to watch the fluctuations and complications along the way. Thanks for sharing your experience and I hope things get better soon.
Jessica says
My 60 year old husband had major surgery a week ago, and now is having profound hallucinations. Initially the doctors thought it was the narcotic pain medication, however, he has not taken any all day, and his hallucinations are getting worse. I’m likely going to return to the hospital, as this is scary for all of us.
Leslie Kernisan, MD MPH says
Sorry to hear of this. Yes, if his symptoms are getting worse, then it’s definitely a good idea to alert his doctors and get more help assessing what might be causing or worsening any delirium symptoms. good luck!
Jackie Dack says
Our 82 year old Mum has been in ICU / HDU for about 10 weeks – and is “confused” but only sometimes. She’s a sharp lady normally, and sometimes she’s still like that – still has her sense of humour etc. You have a perfectly normal conversation and then, out of nowhere she asks why her mother (died 30 years ago) hasn’t been in to see her or where her husband (died 4 years ago is) – What to say? My sister, has had training for dealing with dementia patients, said she was told it is best to not upset her so she just fluffs the answers and says “Oh, they came whilst you were asleep” whilst a nurse on HDU told me to “keep her in reality” – just tell her “They passed away 30 years ago and you know this.”
Which is the correct approach? (Our hearts are breaking here!)
Before hospital, she was starting to get very forgetful but that’s all. She’s had a nasty UTI and has been on mega anti-biotic runs.
Will she recover? Chances? Anything else we can do to help?
Leslie Kernisan, MD MPH says
I’m sorry to hear about your mom’s situation, I can imagine how hard it must be to see her still confused at times.
I would agree with your sister: the general dictum when it comes to dementia and delirium is that you should not insist on getting someone grounded in reality, it’s much more important to help them feel reassured and to avoid stressing them.
Now, in hospitals we do sometimes encourage staff and family to help keep the patient “oriented” to what is going on, with gentle reminders about where they are, what’s been happening. This might be part of what the nurse is referring to.
I usually recommend that people pay attention to the effect of their words. It can take a little trial and error to find out what the most reassuring and constructive approach is.
In terms of whether she’ll recover: many older people do recover once their health conditions stabilizes and they get out of the hospital. It can take a long time (weeks or often even months), especially if they were delirious for a long time, or if they had some cognitive impairment prior to becoming delirious.
If you haven’t yet read them, I would recommend going through the comments on the Hospital Delirium article, as they are relevant to your situation and might give you some hopeful ideas. Good luck!
AJ says
Thank You! These articles have all been very helpful
Leslie Kernisan, MD MPH says
Glad you are finding them helpful!
Lindsey says
Hi, Thank you for your article. My father is 73 had spine surgery in August, went to a rehab facility after where he got a UTI which landed him in the hospital, he was in the hospital for a week and had acute delirium. Ultimately went back to the rehabilitation facility where things begin to clear up, and got better once he got home. He was at home for about a month, and got another UTI which landed him back in the hospital. At the hospital he had a very bad reaction to medication they gave him which landed him in the ICU. He has since again to have the delirium again. But worse this time as it’s been a longer Hospital stay. They would like to transfer him to a Skilled Nursing Facility, but we’re wondering if the delirium will clear in that type of setting or not? Thank you.
Leslie Kernisan, MD MPH says
So, in principle delirium can clear in any type of setting. What affects delirium clearing is:
– Did the provoking illness or problem get treated?
– Are aggravating factors (which we can call delirium contributors) being minimized? Common delirium aggravators include poorly treated pain, constipation, dehydration, not having hearing aids or glasses, not getting out of bed enough, and so forth.
– Is the person able to get enough rest and recuperation?
– How resilient was the person’s brain before developing delirium? How physically resilient is the person?
Your father has unfortunately had three hospitalizations in the past few months, and was sick enough to be in the ICU this last time. This means he’s pretty physically and mentally depleted. People like him can recover, but the more depleted and weakened a person is, the longer it can take to recover, and the more vulnerable the person is to tipping back into delirium again.
The trouble with a skilled nursing facility (SNF) is that many older adults do not find them very restorative. Depending on how they are run and staffed, the situation may even aggravate a person’s mental state. It’s also possible for an older person in a SNF to develop a new complication or infection.
Many SNFs are not ideal for people who have been delirious. In terms of recovering from delirium, it’s probably better for an older person to go home and get skilled rehab services from home health. But that’s only possible if a person is medically stable enough, and if family members are able to provide a lot of support and assistance, especially in the first days home. So, you may have to go with the SNF. Do try to stay as involved as possible, as that can help with recovery.
I hope he starts to get better soon. Good luck!
Kendra Nestor says
Thank you so much for posting this article. My father is currently in the hospital, and is suffering from hospital induced dementia. My family is heartbroken to see this rapid decline in his mental state and the hospital staff who just wants to pump him up with medication to make his sleep. They even raised his bed and then tilted it downward so his head was below his feet. We asked the nurses why this was done and they advised us this is common practice to keep the patient from trying to get out of bed.
This article is so timely and comforts me and my sisters as we now have a little more knowledge about this condition.
Leslie Kernisan, MD MPH says
Glad to be helpful. So sorry that your father has been experiencing this problem!
You may want to ask more questions about what medications he is being given to “make him sleep.” Hospitals sometimes administer sedating antihistamines or benzodiazepine sedatives for this purpose. But in geriatrics, we generally try to avoid using these, as they can make confusion and delirium worse.
Good luck, I hope your father starts feeling better soon. Most people do eventually get better, but it can take time, and it’s a stressful experience for everyone while the delirium is bad.
Miranda Wolhuter says
Thank you for the very informative articles. Great food for thought!
Leslie Kernisan, MD MPH says
Glad you found this helpful!
Cathrine Baldwin says
Have you any help for families taking home their loved one who has delirium? I am living the experience with my sister’s and brothers and it would appear that there is no help from the mental health! Just keep getting told to seek social care but it’s only happening at night from 12:30 to 4:30am.
Leslie Kernisan, MD MPH says
Usually our advice to families is to continue with supportive care: a reassuring, restorative home environment, minimizing overstimulation, etc. It’s usually best to not argue with anything irrational or odd that is said, and instead try to soothe the person.
If the confusion seems to be getting worse, then you should bring it up with the doctor. Sometimes an older person’s underlying illness relapses, or a new problem arises that might provoke delirium.
Has your sibling recently been ill and diagnosed with delirium? Was there pre-existing Alzheimer’s or another dementia? Symptoms just during the night would make me wonder about an older person developing some day-night confusion, or perhaps even some sundowning.
You might get some ideas on how to manage nighttime confusion or sleep difficulties in one of these articles:
5 Top Causes of Sleep Problems in Seniors
How to Manage Sleep Problems in Dementia
Definitely talk to your sibling’s doctor about this problem!
Noreen says
Love your articles on delirium. Also leg swelling. Just do not know how to reply. Here goes,
I was hositalized one day before 81st birthday for hypothermia because Denver Archdiocese Housing Corporation has no t hermostats and it was either turn heat on or off, freeze or burn up from too much heat. My body temp was 93.8 degrees and I was found nonresponding. I wish they had let me alone. Old people do not need to be revived. Let them go! I hate it that I became so ill because people cannot let older folks go. I since have DNR and MOST form so won’t be bothered again by interfering people. I ended up with delirium and then they kept trying to treat me for everything and my primary care doctor at another medical center did not protect me. The entire episode resulted in Archdiocese of Denver hud housing trying to evict me. I had to move.
Noreen says
Also, I am smarter than the average 81 year old and remember every evil thing they did, drugging me with antipsychotics and other disabling drugs and putting in piccine which I removed to stop drugging me. It is a horror story I posted online. I never wanted to be revived.
Nicole Didyk, MD says
I’m sorry you’re having so much stress about your housing, and it sounds like it’s affecting your health.
When you mention DNR, or “Do Not Resuscitate”, you express a sentiment that I’ve heard on occasion from some of my patients. Dr. K has a good article about advance care planning, including a discussion of the POLST (Portable Medical Orders or Physician Orders for Life sustaining Therapy). You can check out that article here: /polst-resources-tips-avoid-pitfalls/
It’s vital to let the people in our lives who may act as attorneys or substitute decision makers know about our preferences for medical care in the case we can’t speak for ourselves. That way, if a person is too ill to convey their wishes, their family member can do so for them.
In my province we have a “DNR” form that can be signed by a doctor and posted in the home, so that an emergency medical responder can see it and know not proceed with CPR or other interventions.
I’m sorry that you had such a negative experience and I would encourage you to have a discussion with the people in your life about what your wishes are, to avoid a similar situation in the future.
Lisa says
Please comment on possible causes of the early morning delirium . My mother too has delirium episodes usually between 2-4 am but may also be affected during daytime . Would an electrolyte imbalance or elevated/ lowered blood sugar ; blood pressure be responsible ? Who would be best to diagnose – a neurologist/ gerontologist?
Thank you
Nicole Didyk, MD says
There can be daily fluctuations in the levels of alertness and cognitive performance in a person living with dementia. You don’t mention whether that’s the case with your mom.
It’s possible that significant sudden changes in blood chemistry or blood pressure could cause confusional episodes but there may be other triggers related to the environment, medications, or some other factor that’s more likely to be the culprit.
A geriatrician would be able to do a comprehensive assessment and help iron out the issues and give you some clarity.