Better Health While Aging

Practical information for aging health & family caregivers

10 Things to Know About Delirium

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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.

  1. Health providers must identify and reverse the illness or problems provoking the delirium.
  2. They have to manage any agitation or restless behavior, which can be tricky since a fair number of sedating medications can worsen delirium.
    1. 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).
    2. The once-popular practice of physically restraining agitated older adults has been shown to sometimes worsen delirium, and should be avoided if possible.
  3. 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:

Last but not least, for my previous posts on delirium:

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. 

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Comments

  1. This is a very informative forum ! My dad is 96 , and in incredibly good health , has lived on his own w/ some assistance. Last night he was admitted to a hospital w/what we thought was a bowel obstruction. Turns out severe constipation that had no doubt been going on for months . A 2 day aggressive process of “cleaning him out” ensued & let to serious problems with his kidney #’s . 2 days in he also “changed” mentally . Talking utter nonsense, spinning tails if you will . His routine was so out of whack as were his electrolytes & potassium levels . He would be ok one minute then totally unrational the next. Could all this be classified as hospital delirium? He has no history of any dementia or Alzheimer’s, & cognitively was fine before entering the hospital. He stayed a week & entered a rehab facility yesterday. He is better , much better , but the staff & myself In talking over the phone with him still notice a bit forgetfulness , but thankfully not spinning any tales . What do you think his chances are to be back to normal cognitive behavior?

    • Hi Kelly and sorry to hear about your dad’s difficulties.

      It sounds like you’re describing a delirium with the fluctuations, “spinning tales” (which we might call delusions or hallucinations) and changes in concentration and level of alertness. Thankfully, delirium almost always gets better, although for some the return to the prior baseline level of thinking and function isn’t 100%. It’s difficult to predict how much a person ill recover and only time will tell, really.

      There’s no pill to “cure” delirium, and the best treatment includes physical exercise, promoting restful sleep, and getting back into a routine. I made a YouTube video about delirium which you can watch here: https://youtu.be/uKp3sGwk4Tc

      You might also be interested in this article about constipation. Your story is a good reminder that a seemingly minor challenge like constipation can lead to serious problems.

      Thanks again for your comment and I’m so glad you find the website informative!

  2. My mother is 95 and has had Alzheimer disease for almost a decade. But she has been at a constant level and has recognized all of the immediate family and been able to enjoy our stories and respond appropriately to our conversations. But then she developed a urinary track infection that was not identified for two weeks or so. She then received antibiotics but became significantly more detached and unsteady enough that her caregivers in the memory home have her in a wheelchair for fear she will fall if she continues using her walker. Her doctor checked her out after she finished the antibiotic. They took a blood test but did not find anything wrong. At this point the advice is that we move forward with comfort care. We are heartbroken at the sudden decline and it certainly seems from your article that she may have suffered from delirium from the UTI. I am left wondering if we should be taking other action in trying to get more clarity and help for her, or if this is just the unfortunate turn of events that we deal with moving forward

    • I’m so sorry to hear about the changes you’re seeing in your mom. This is a familiar story when a seemingly small challenge like a UTI can be a major setback. Unfortunately, this can lead to a cascade of changes, like using a wheelchair more often, that will then compound the difficulties (through reducing mobility, contributing to weakness and falls risk). Sometimes, this is irreversible, and does lead to an ongoing decline where a focus on comfort makes the most sense.

      In my experience as a Geriatrician, though, an older person can often rally with a return to regular routine, good nutrition, physical activity and trimming away any unnecessary medications. A consultation from a Geriatrician might be helpful to identify any reversible issues that the team at the memory home have missed.

  3. My grandmother is 81 years old and has always been in perfect health. No out patient procedures, no surgeries. She was diagnosed with stage 3 kidney disease, but is just being “monitored” for any changes. Over the past month she has complained of a “fluttering” in her ear and severe headaches. Then a few days after Thanksgiving, she forgot a phone conversation she had held earlier in the day and could not remember what she had for breakfast. The next day, we took her to her primary care physician where he said he still didn’t see anything in her ear and she was probably beginning to show signs of dementia or Alzheimer’s. We were to return for follow up in 6 weeks. However, she progressively got worse. She would only give one word answers when asked questions, typically yes or no. Sometimes, I don’t know. She wasn’t really able to carry on any type of conversation and this got worse over a period of days. I took her to an emergency room. They ran urinalysis, blood work and ct scan. No infection and metabololic panel looked normal. CT scan showed age related, shrinkage of brain which he then eluded to dementia. I asked if dementia, would we not have gradually seen some type of cognitive decline? He said it was possible that she could have had a ministroke that exacerbated the condition. He then sent us home to again follow up with PCP. Every day her mental state has worsened. Last week, we saw her PCP and he prescribed her busiprone and trazadone. This week, there has been no improvement and her condition has actually worsened. She is now fighting us with everything we ask or need her to do. She won’t eat, she won’t take her meds, she won’t bath. She is cussing (which is NOT at all normal), she tells my mother, whom is caring for her, to go home and leave her alone! TSo again, we take her back to PCP yesterday and we demand he send her to hospital for further evaluation. (She actually laid herself in the floor and had a tantrum to try to avoid going to the doctor. My mom and uncle had to DRAG her out and basically put her in the vehicle) He says that there is NOTHING in any of her test results from ER visit that is making him think she has anything other than cognitive impairment. I said what about all this medicine that she is prescribed, could she be suffering from seratonin syndrome. He said that it could be possible than in an attempt to make her better, prescribing her the busiprone and trazadone has only made her worse. He stopped all meds except for : Lexapro, Ativan, Lisinopril and a thyroid medication. He said to return again in a week to see if that change in meds has helped but also implied that we should be getting ourselves prepared as this condition will probably not improve.
    As I have mentioned before, my grandmother has NEVER done anything to make us think she was getting dementia. It is no exaggeration when I say this literally sprang up over night and has just gotten worse with each day. I must note that prior to the doctor giving her busiprone and trazadone, he had also prescribed her Remeron(30mg) which she was to take for sleep and for several weeks leading up to this change in behavior, she complained about all the dreams she would have and would often times have a hard time “shaking” them when she woke.

    We are so confused and do not understand any of what is going on. I believe that someone else needs to take a second look at her, though I am no sure in her agitated state, how we would get her to go or cooperate. I am thinking a neurologist but would a mental health facility be better? Any type of advice you could give us would so greatly appreciated. She has been this way since Thanksgiving and it sure would be nice to know that if there is something else going on with her, other than dementia, we know about it because maybe we can HELP her!

    • I’m sorry to hear that your grandmother is having so much difficulty and it must be very hard on your family right now. It sounds like you are all noticing some significant changes and seeking help as best you can.

      The medications that you mention are mostly prescribed for depression, anxiety, and insomnia (Buspar, Lexapro, Remeron and Trazadone), so if I saw someone who had been prescribed those medications, I would be curious about whether they had struggled with those conditions. Dementia can certainly cause changes in behaviour and language skills, but those psychiatric conditions could do that too. Just to make things more complicated, the medications themselves can have side effects that can bring abut such symptoms as well. See this video about anticholinergic medications for example.

      A Geriatrician would be able to sift through all of the different medications, underlying medical issues and current behaviour changes, and give some advice about how to get clarity on the diagnosis and treatment. I would advise someone in your situation to advocate for a referral form the PCP. Best of luck.

  4. Hello – lots of good information here! I am searching for input on finding a care team equipped to understand and treat delirium in my 83 year old mother-in-law.

    4 weeks ago she had a knee replacement. Prior to the surgery, she had full physical and cognitive function – no apparent diminished capacity. Within about 8 hours post-op, she was in what we later found out was hospital-induced delirium – severe aggression, confusion, delusions, etc. Her Dr. felt like it would clear over time. She was starting to get a bit better, with moments/hours of clarity. After 8 days, she was moved to a skilled-nursing facility for Rehab, with orders from her Dr. to cease all meds in order to promote cognitive clarity.

    Her mental state was up and down over a period of a few days, but progressed into being pretty poor again, particularly at night. She was very combative with the staff, very confused and couldn’t seem to interpret reality from her dreams, etc. They “released” her (kicked her out) at 11:00pm on a Friday night 2 weeks ago to have an ambulance come get her and take her to the hospital for extreme aggression.

    The ER determined she had a UTI, and we quickly learned that can add to the confusion. We also found out the rehab center had her on a plethora of drugs to calm her down. She was treated in the hospital for a UTI, but her confusion continued off and on. They initially had her on only a small dose of Olazapine, Because her mental status had not cleared but her UTI did, they moved her to the Senior Behavioral Health Unit after 5 days, and she has now been there for 5 days. They just seem to be pumping her full of different anti-psychotics (Respidol for 3 days, then Halidol & Ativan) and no real treatment plan. Her nursing staff and psychiatrist also change frequently, and when I spoke with her new assigned psychiatrist today he had no history of the last 4 weeks, thought she had long term dementia and was surprised to find out she had not, etc. In fact, when I questioned her treatment plan the nurse stated they are just trying to manage her, and just wanted to push me off on a social worker.

    I am not at all satisfied with her care team. I want to find a physician that understands delirium and can actually present a recommended plan and prognosis, but am unsure of how to do so. Are there some resources that you can recommend for finding a Dr. that specializes in these issues? The family is very frustrated and we don’t know where to go for help.

    Thanks! Anita

  5. Hi there. My father (81) has delirium following cancer surgery in January. We moved him to an assisted living home and our family visits as often as we can. But I wonder if there’s anything you could suggest that might give him something to do during the day. He stares at the TV (seems to prefer things like The Price is Right and court shows) but he can’t follow storylines well enough to watch a movie. He also has no interest these days in reading a newspaper (he scans it but doesn’t absorb it). He just rests a lot, but I would love if you could suggest something for him to do. Puzzles maybe?

    Thanks for reading and for all your responses. Very insightful!

    Rick

    • Hi Rick
      I’m so glad to hear that you are able to frequently visit your dad! There are a lot of puzzles, games and apps that are designed to boost brain performance, and some of them have been shown to do so (or at least people can improve their performance at the tasks in the game, but whether this translates into better function or more independence has not really been demonstrated).

      The best kind of activity is one that will actively engage your father, both physically and mentally. If there are exercise classes or social events at his facility, he should be encouraged to attend (and may need someone to knock on his door and invite him until it becomes a habit for him). Eating his meals in a dining room with others is also a therapeutic intervention. Hope that helps.

  6. My dad is 67 years old and has not been eating well since 4 months ago. He’s a heavy smoker and drinks hard liquor on a daily basis for more than 30 years now. He needs assistance in walking now due to lack of nutritions.

    He has been admitted to hospital last Saturday as his potassium level is very low and has been on and off confused state.
    He was fine on Thursday and Friday but when Saturday comes, he started talking nonsensical stuffs, he couldn’t even tell us where he is now and keeps wanting to go home.
    We are really worried on his condition and not sure how long will he take to recover. My mum can’t care for him alone even if he goes back home. The doctors can’t give a concrete answer to how and why is he acting like this. They tied him down to the bed as he could turn violent.
    It’s really heart breaking for family member like us.

    • Sorry to hear of this story, it does indeed sound worrisome and very sad. It could indeed be delirium. Another possibility, if you say he drinks hard liquor every day, would be that alcohol withdrawal is playing a role.
      I hope that by this point, the doctors were able to help stabilize him, and that he gets better soon. good luck!

  7. My father is 93 years old and had a prostate cancer 10 years ago. He is in remission and no longer have prostate cancer. However, as a result of the radiation, he has been having some bladder bleeding due to the thinning of the bladder wall and has been on a catheter continuously for over a year. A Homehealth nurse would come to the house and flush or change it once a month or as needed. The catheter has been giving him UTI on and off and his doctor would prescribe antibiotics. A couple of months ago, he has been paranoid and aggressive solely towards my mom. His mind is still sharp as he can carry on a conversation and would remember everything. He never exhibited suicidal tendencies until a month ago, he got suicidal to the point that he called 911, police came and eventually the paramedics took him to the ER and was put on a 5150 hold and was sent to a psych hospital. The hospital medicated him so bad that he was drooling and shaking. So we begged them to release him to a skilled nursing facility as he is not psychotic. The psych doctor thought it could have been the UTI that caused him to have delirium. He is still at the rehab and taking risperdal 0.125 mg and trazedone. It has been a rollercoaster ride because he would be in a good mood but then calls my Mom and goes back to the old paranoia accusing her of infidelity. My mom is 83 years old with osteoporosis and hunched back. Prior to this incident, he has shown some aggressive behavior and throwing stuff or threatening to harm my Mom. He is still at the rehab but I fear for my mom’s safety if he comes home. He is only allowed for a short stay and then he can come home or go to an assisted living facility. Trying to figure out if the risperdal is the right medicine for him. The Neuropsychologyst who evaluated him says he doesn’t exhibit any dementia and that he was alert and in a good mood. That is the irony of it, he doesn’t show any aggression towards the staff or to us – only to my Mom. Does this sound like delirium? I don’t know what to do – I need help! Thank you and I appreciate this forum. It’s been very informative.

    • Hm. Well, at age 93, his brain in general probably has underlying damage and is very vulnerable. If he was already showing signs of paranoia and delusions a few months ago, my guess is that he’s developing some chronic thinking problems, which will likely get worse when he has a UTI or otherwise is under physical stress.
      Drugs like rispderdal can sometimes reduce aggression or frank paranoia, but they also increase falls and can cause sedation. I cover those types of drugs and their risks here: 5 Types of Medication Used to Treat Difficult Dementia Behaviors

      Honestly, he might get a little better as he recovers from this hospital stay, but since he started having the problems a few months ago (and the bladder issue is a chronic problem), I think it’s quite likely that he will continue to have these problems, and they might slowly get worse. So starting to plan for a different care arrangement eventually may make sense. If you’re concerned for your mother’s safety, it would be good if you or someone could stay with her and your father once he comes home. You’ll have to see what the situation is like.

      Good luck!

  8. My dad has been very confused and was taken into hospital last Tuesday. He has rheumatoid arthritis and diabetes, and hasn’t been taking his meds properly or eating much. He has been saying how much pain he was in. Also he was very constipated. Since being in hospital he has had laxatives and His meds being controlled better. He is due to get a CT scan but I feel hes definitely less confused. Does this sound like delirium?

    • Yes, it does sound like it could be delirium. I would recommend you ask his doctors for more information, they should be able to advise you. That is great if he is already better! Good luck!

  9. My 86 year old father had a fibulator input. Before the surgery he had a very difficult time breathing. He now has delirium. We is in a rehabilitation center for therapy. However, he gets agitated, tried to leave the center and has confusion. Our doctor has prescribed risperidone. He has been on this medication for 2 days. He is still confused. My concern is for his safety. He is not able to come home and with this confusion should we consider a facility that provides memory care. This is so difficult and my family does not know what to do.

    • Sorry for delayed reply and sorry to hear of your father’s delirium. Risperidone and other antipsychotics have not generally been shown to help delirium resolve, they mostly mask the more agitated symptoms by causing some dampening of brain activity.

      Generally to recover from delirium, people need rest, a restorative environment, and time. Getting out of bed and walking regularly also helps, it’s part of the body settling into a normal rhythm (lying in bed all day does not feel normal to the body). Of course, when people are confused, they need reassurance and also some level of supervision. Personally, I think many older adults feel better when they are in familiar surroundings, but it can be hard for families to provide the necessary supervision and help while the older person is recovering.

      I hope he’s gotten better at this point. If not, I would recommend talking with his health providers about how he is doing, and a social worker can help you brainstorm ways to get him the care and support he needs. Good luck!

  10. This has been one of the most informative websites I have found. Thankyou! My 86 year old mum has been in hospital for 2 weeks. She was diangnose with pneumonia, sepsis, aspiration and then gall bladder infection. Treatment with
    Antibiotics have worked however we now think she may have had a stroke. Right hand side of face had dropped and her speech very slurred. Doctors said she had delirium and up until the potential stroke she was communicative although talking strangely.. dogs in the ward,nurses trying to kill all the patients. Now she is sleeping all during the day and not very responsive. She now has fluid on her lungs which they have given her diuretics and ‘re catheterised her which is working. They have also given her anti vitals in case she has a viral infection in brain. We are waiting on her to get MRI as CT scan showed nothing. Echo showed heart ok. They are struggling to get her O2 levels right and said she arrived in Hopsital in AF and with level 2 Resp Depression. She is not eating. I live 8h drive away but my sister lives local to hospital. She is not in good health either. Doctors say different things each day and I am not sure if outlook is positive or negative and they won’t commit other than she is seriously ill but they are being hopeful. The longer delirium goes on worse the prognosis. I am.considering asking to work from home so I can stay at my sisters and share hospital visits or taking unpaid leave to be in hospital. But reading the comments it is difficult to predict how long this may be for. Any advice would be appreciated. Apologies for long ramble. By the way I am in UK

    • Glad you have found the site helpful but sorry to hear of your mother’s difficult situation! If her face was drooping and her speech became slurred, a stroke or TIA is certainly a possibility, and it does sound like she’s otherwise been delirious and very sick. Poor thing.

      In terms of recovering: the longer the person is sick in the hospital, the longer it tends to take to recover strength and function. Also it takes longer if the person was weak or impaired or chronically ill prior to being hospitalized.

      It sounds to me like first she needs to get through this acute hospitalization, and then you can see where things are at. Good luck!

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