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.
Joe says
Thank you for this very informative article.
My wife who is only 65 years old has become very quiet and doesn’t engage in conversation like she used to.
Her sister called me with her concern as well.
She did have a UTI and was prescribed Cipro that did make a difference as she was her old self but has since reverted to becoming quite once again
After reading your article I’m calling her doctor with the hope that she’ll talk to me.
Nicole Didyk, MD says
I’m glad you plan to get in touch with your wife’s MD, and thank you for your kind feedback. I’m glad you found the article informative.
A change in behaviour like you describe can be related to different causes like dementia, depression, medication or some other medical issue. You can read more about depression in this article:
K says
Hi. Thanks for your informative articles. My grandmother has been experiencing delirium for the past month or so. It comes and goes throughout the day – sometimes we will call her and have a thoughtful, normal conversation with her, and other times she will say things that don’t make any sense at all, or aren’t true. She isn’t forgetful, and it’s not like she doesn’t recognize things or people.
She had a “whopping” UTI in September and was treated for it and the delirium got better. She gave herself very bad hemorrhoids which caused a temporary fecal incontinence problem. She has macular degeneration and cannot see well to clean herself when this happened, so we hired two caregivers to help her out. Unfortunately, they restricted her from doing her usual activities – laundry, ironing, cooking, etc. My grandmother is otherwise quite well – she lived alone until we hired the health aides – and took care of everything herself. She liked having help doing some things – changing sheets, cleaning the blinds, and other bigger tasks, so we decided to keep them on.
It became too expensive to have two aides, so we hired a live-in person. Since the person has been living there her delirium has gotten much worse (it’s been about 2 weeks). Granted, the person is a clean freak and is cleaning the house from top to bottom to the point of ridiculousness. She also likes to have things “her way.” Well, now grandma is sure that this woman is going to drug her or steal from her or something. She doesn’t trust her at all and I think might even be afraid of her. The other aides helped her out but they also sat down and had dinner with her, chatted, and were a source of social interaction which was helpful I think. I don’t believe this woman does that.
At the beginning of this ordeal, she was so confused that she was getting her days and nights mixed up, and not sleeping well.
Since my grandma doesn’t trust this new live-in or like her, we are thinking of getting someone new – BUT do you think yet another change in her living situation will make things worse? Do you think it’s possible that she has another UTI? Is it purely the fact that her life has been disrupted by someone coming in and trying to take over her house (she mentioned today in her delerium that she must have to pay more rent in order to stay at night… as if the house is not her own), causing her delirium? Is it her vision? Her hearing has gotten worse in the past year – could that be compounding it? Sometimes she realizes what she said is wrong and will say something like “Why did I say that?” or “Why did I think that?”
She is 96 years old, takes blood pressure and cholesterol medication, thyroid medication, an anti-depressant, a probiotic and multi-vitamin, and I think that’s it. She was in the hospital once about 10 years ago and experienced delirium, but as soon as she returned home she was fine. Also of note, she has night terrors, and very scary/vivid dreams, though she never remembers them. This has been happening for probably at least 30 years.
Nicole Didyk, MD says
Thanks for your detailed description of what your grandmother is experiencing. It sounds like the situation with her caregivers is not the best fit.
A urinary tract infection (UTI) can definitely be a cause of delirium, but so can stress, a significant change in living environment, sleep deprivation and almost any medical illness. It could also be related to a combination of those things, and the sensory impairment due to low vision doesn’t help either.
You don’t mention if your grandmother has cognitive impairment aside from her delirium, and that could be a part of the puzzle. A Geriatrician or Geriatric Psychiatrist would be a good professional to help sort that out and do a comprehensive assessment. This article about cognitive impairment has some good tips about what to look for and what a doctor should assess: /cognitive-impairment-causes-and-how-to-evaluate/
Delirium can take weeks or even longer to resolve, even after all of the medical issues have been corrected. Being in a familiar place and a predictable routine can help. Your grandmother is lucky to have such a caring and involved family and I hope things improve with time.
K says
She doesn’t have any cognitive impairments besides her delirium, as far as I know. She doesn’t have any memory issues, as far as we can tell. She sometimes mixes up the names of my brother and her son, but she doesn’t think they are each other, if that makes any sense. And she corrects herself usually.
As far as thinking is concerned, she can reason quite well. She does worry a lot and has some irrational fears, but she has always been that way. She doesn’t trust anyone.
If she’s “out of practice” doing something – like using the stove or the washing machine, she can get confused with the buttons, but usually figures it out with some help from myself or my mother, and then she’s fine.
Something else I didn’t mention – she had gone for a hearing evaluation several months ago as part of a routine ENT visit. As expected, she has mild to moderate age-related hearing loss. She REFUSES to go back and see an audiologist or get a hearing aid. I have a feeling that this impairment may be also affecting her mind.
We are working on changing her live-in caregiver. I am hoping that will help.
Thank you so much for your advice!
Nicole Didyk, MD says
Thanks for the update!
Many patients in my practice struggle to use hearing aids effectively, and you’re right that hearing impairment can worsen cognitive performance. I often refer people to the Canadian Hearing Society for information about other devices that can help, such as a pocket talker, which I use in my office with amazing results! In the United States, try the Hearing Loss Association of America.
The Tech-Enhanced Life website has a wonderful topic hub about hearing gadgets which night be helpful: https://www.techenhancedlife.com/hub/hearing
Kathryn says
Hi Dr. Didyk,
It’s me again! My grandmother is doing much better now that we have gotten two new aides (one for weekends and one during the week).
BUT she is still experiencing some delirium (though much less than before). When she is out or at our house she is perfectly fine, and she rarely says anything unusual (with the exception of saying something like “well the institution I’m at…). When she is home, though, she thinks she is living in an institution of some sort (or a hotel). I don’t know if it’s because there is a strange person sleeping at her house, or what. She constantly has at the back of her mind that someone is either selling her house, or renting it out to other people, and she will bring it up that she’s very worried about it.
She knows her address, and sometimes she knows she is at home, but rarely. She also seems to think that there are multiple people in the house, not just one. She is afraid that shenanigans are constantly going on in her front room – strip shows, puppets, a dog that was snuck in, etc. It’s so strange because she has lived in the house since she was about 10 years old, so it is absolutely the most familiar place to her.
I’m pretty sure at this point that it is all psychological. She has no cognitive or memory issues at all. We took her to her PCP and she is as healthy as a horse in terms of her bloodwork, and said nothing unusual. Besides the fact that she needs to gain weight, the doctor saw nothing out of the ordinary.
We took her to the eye doctor and he diagnosed her with Charles Bonnet syndrome, which means that some of the things she sees she really is seeing. Now that she has a diagnosis she knows when she sees something strange it is not real and can make it go away (for a while anyway).
But none of that points to why she is thinking such strange things are going on, or why she doesn’t think she is home a lot of the time.
What do you think? Could there be some other physiological issue that I am not addressing or haven’t thought of? Could it be that is all psychological and a response to stress (she also had a lot of trauma in her childhood)?
If so, how do I convince my mother that she should be taken to a geriatric psychiatrist for at least an evaluation?
Thank you again for your help. I can’t tell you how much I appreciate it.
Leslie Kernisan, MD MPH says
Hello Kathryn,
Dr. Didyk is on leave for a bit, so I will jump in. In my experience, the types of strange beliefs your grandmother is experiencing can be associated with other cognitive symptoms. They can sometimes be caused by electrolyte imbalances or other medical issues. Her memory or cognition may or may not be fine. If you want to check for other concerning cognitive signs, I have a whole list of them in my book When Your Aging Parent Needs Help.
The book also has lots of tips and suggestions on how to get an older person evaluated.
You might be able to get it for free through your local library. Or you can purchase it and a few dollars of your purchase will help support Better Health While Aging.
Good luck!
Ellen says
My 91 yo mom had a reaction to a new bp med she was given. After about 3 weeks on the med, she became delusional. Long story made short, she did not clear up, so after a week long hospital stay, she went to a nursing home. She became a little clearer for a brief week or two, then began slipping back into delusions and making up her own words. She continues to get worse and worse. She’s now a total assist, is able to sit up in a wheelchair, but doesn’t respond to people calling her name. She’s being checked for a UTI at this time. Prior to this episode 4 months ago, she was living alone, albeit with dementia.
Sometimes I wonder if she would have completely cleared if we had brought her home. I guess I’ll never know the answer to that.
Nicole Didyk, MD says
It’s heartbreaking to hear of how quickly your mom seems to have declined. Definitely highlights how delirium can lead to a person becoming more dependent and needing more help.
I would try to avoid second guessing yourself about whether something different could have been done. Even with optimal and prompt care, delirium can still cause an increased risk of functional decline and even death. If your mom gets another UTI or needs to go in hospital, there are things you can do to prevent another delirium episode. You can watch my video about it here: https://youtu.be/jtEBF6Jb6z8
I hope your mom improves, and don’t forget delirium can take several months to clear.
Tara says
Hi, my 85 year old father went into the hospital with what looked like a TIA or stroke because he seemed aphasia and had a hard time communicating. But stroke, all infections, meningitis and vitamin deficiencies have been ruled out. He does take some medications like ambien, Ativan, gabapentin and celexa in addition to warfarin and Harare medications for afib daily. The physician feels this must be a buildup of medications in his system but has labeled it acute delirium. Is this reversible? He is not able to speak much except for common phrase like “ how are you” and he answers yes no and “idon’t know. “. It’s been almost two weeks and not much change has been noted. He is not taking any medication except for his heart medications and melatonin. Can this be reversible and how long does it take?
Nicole Didyk, MD says
I’m sorry to hear about your father’s difficulties. Unfortunately, delirium is common in older adults, and is always caused by some medical issue. Medications are quite often the culprit.
I made a video about delirium and it’s up on my YouTube channel: https://youtu.be/uKp3sGwk4Tc
Delirium can take days, weeks, or even longer to get completely better. Even after the offending medications are out of a person’s system, the delirium symptoms can persist. It’s frustrating for families and medical professionals alike.
Dr. K has an article on what you can do to prevent delirium, and these strategies can help a delirium to get better more a=quickly as well :/hospital-delirium-what-to-do/
I hope that in time your father is back to his old self.
Kim Church says
Can a very low dose of lorazepam cause delirium in an elderly patient with vascular dementia? My mom lives at home and I’m trying to find safe ways to manage her agitation. Thanks!
Nicole Didyk, MD says
Lorazepam is a benzodiazepine, and we usually try to avoid this type of medication in older adults, especially those with dementia. Dr K has an article about medications to avoid for brain health: /ags-beers-criteria-medications-older-adults-should-avoid-or-use-with-caution/
When it comes to an older adult with agitation, it can be helpful to try to figure out what there is in the environment or in the person’s health status that might be a trigger. Making changes to avoid the trigger can often be safer and more effective than use of a sedative.
Jane says
Thank you so much for this article, which has been very helpful in understanding my 90 year old Mum’s situation. My Mum has experienced several episodes of delirium over the last 6 months and the underlying trigger has been infections, exacerbated by stress, anxiety and dehydration.
My Mum is currently better and much more clear headed. My question is whether she has any memories of the hallucinating thoughts she had while delirious?
Nicole Didyk, MD says
I’m happy to hear that your mom is better now. Delirium can be very frightening and in my experience, many people who hallucinate or have delusions during an episode of delirium recall them and realize that their mind was playing tricks on them. Sometimes they will even be apologetic for their behaviour related to the hallucinations.
If they were disturbing to her, I would respond with reassurance and distraction. Hope she stays well!
Ravishankar says
I have seen similiar problems with elders accusing their otherwise dutiful wife of infidelity.
This ussually happens with Psychosis
Nicole Didyk, MD says
You’re correct that delusions of infidelity are common, and can occur in delirium or dementia, among other conditions. There’s even a name for it: “Othello syndrome”, a reference to the character from Shakespeare. You can read more in this article: https://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2012.02386.x
Zoraida says
Should one agree with someone that has delirium when what they’re saying is absolutely wrong or change that subject .
Than
Nicole Didyk, MD says
Someone who’s experiencing delirium can have hallucinations, delusions, and very disorganized thinking. Sometimes the person will insist that they see or believe something that doesn’t line up with reality.
In this case, I would advise not reorienting to reality, or doing so very gently. I would validate the person’s perspective (after all, it’s very real to them), and try to move on to more reassuring topics. You don’t need to go so far as to agree, but validation and reassurance are a good way to go.
Anne says
Thank you for the information and the time you take to answer questions! My mother in law is currently in a rehab facility in AZ (we live in PA) with a range of maladies: swollen hand that doesn’t work; inability to get out of bed (or walk), and complete incontinence. She’s also diabetic. After reading about delirium, I’m convinced she has a solid case of it. Her 48 year old daughter is with her now, but functions at a very low level mentally and can’t make rational decisions. That’s the background. My husband’s mom is mad at the facility she’s in and calls him daily ranting and raging and declaring that she’s going to go home. She has the 48 year old daughter telling everyone that there’s nothing wrong with her mom. Of course this seems utterly irrational, given my MIL’s inability to walk, use the bathroom, or remember basic words when trying to speak. We certainly feel for her and wish we could be helpful. (Going to AZ at this time is not an option.) If you have any insight, we’re all ears. Thank you so much.
Nicole Didyk, MD says
The rages and rants you describe could be symptoms of delirium, especially if it’s a change from a previous pattern. It certainly sounds like there’s a lack of insight on your MIL’s part, which can be seen in dementia or delirium.
The staff at the facility may have experience with this type of response and are likely working with her to get her into a routine and back to as functional as she can be.
If your sister-in-law is sharing inaccurate information with other family, there’s not much you can do to counter it without expending a lot of energy and possibly stirring up conflict.
I would communicate with the care team at the facility and share your concerns about delirium. If you can have a conference with them, even better (this can probably be done virtually). Asking for a consultation from a geriatrician is a good idea too.
Jennifer says
I have a family member that is in her mid 70’s. She is experiencing some delirium. But she understands that she sounds crazy to people that she tells about these episodes and doesn’t want help. When in the presence of a dr she comes across as very lucid. And claims the family member that was with her is abusive. The dr simply said to take her to the er, but she refuses to go. How can we help her?
Nicole Didyk, MD says
I wonder if your family member is having delusional or paranoid thinking, rather than delirium? Hallucinations or delusions can be a part of dementia in older adults, as I discuss in this YouTube video:https://youtu.be/cjj6NyuPyCI, but can also be related to misperceptions of natural phenomena, distortions from impairments in hearing, vision or the sensory nerves, or part of a delirium.
This article about paranoia has some great information that I think would be helpful: /6-causes-paranoia-in-aging/
If these experiences are distressing to her, then an assessment by a medical provider is important, and if it is delirium, the cause needs to be uncovered and treated. Unfortunately, it sometimes takes a crisis or a dramatic change in the person’s situation to prompt them to seek help.