“How should delirium be managed in the hospital?”
This question came up during a Q & A session, as we were discussing the Choosing Wisely recommendation to avoid tying down older adults who become confused during a hospitalization.
Delirium is a common and very important problem for all older adults in the hospital. It doesn’t just happen to people with Alzheimer’s or a dementia diagnosis. (And, it’s not the same thing.)
But many family caregivers have hardly heard of hospital delirium. This is too bad, since there’s a lot that family caregivers can do to prevent this serious complication, or at least prevent an older loved one from being physically restrained if delirium does occur.
In this post, I’ll review what older adults and families absolutely should know about hospital delirium. And, we’ll cover some of the things you can do if it happens to your loved one.
Why hospital delirium is so important to know about
Delirium is a state of worse-than-usual mental function, brought on by illness or some kind of stress on the body or mind.
It is sometimes referred to as “hospital confusion” or “hospital sundowning.” And if it happens in the intensive care unit (ICU), it is sometimes referred to as “ICU psychosis.”
Although people with dementia are especially prone to develop delirium, delirium can and does affect many aging adults who don’t have Alzheimer’s or another dementia diagnosis. Here are some facts that all older adults and family caregivers should know:
- Delirium is very common during hospitalization. Delirium can affect up to half of older patients in a hospital. Risk factors include having pre-existing dementia and undergoing surgery. Having had delirium in the past is also a strong risk factor.
- Delirium is strongly associated with worse health outcomes. Short-term problems linked to delirium include falls and longer hospital stays. Longer-term consequences can include speeding up cognitive decline, and a higher chance of dying within the following year.
- Delirium is often missed by hospital staff. Busy hospital staff may not realize that an older person is more confused than usual, especially if the delirium is of the “quiet” type. (Although many people are restless when delirious, it’s also common for people to become quiet and “spaced out.”)
- Delirium is multifactorial. There often isn’t a single cause for delirium. Instead, it tends to happen due to a combination of triggers (illness, pain, medication side-effects) and risk factors (dementia, or pre-dementia). This means that treatment — and prevention — often require a multi-pronged approach.
To summarize, delirium is common, serious, and often missed by hospital staff.
Fortunately, there’s a lot that you can do as a family caregiver. In particular, you can help your loved one more safely get through a hospitalization by:
- Taking steps to prevent delirium;
- Keeping an eye out for any new or worse-than-usual mental states that might signal delirium;
- Making sure hospital staff address the problem if it does happen;
- Questioning things if the hospital resorts to tying a person down, before all other options have been tried. (This last one is a Choosing Wisely recommendation.)
How to prevent hospital delirium
Now, not all hospital delirium can be prevented. Some people are very sick, or very prone to delirium, and it’s certainly possible to develop delirium even when all triggers and risk factors have been addressed. Furthermore, many older adults are already delirious when they first get hospitalized.
Still, there are steps that can be taken to reduce the chance of a bad delirium. Experts estimate that about 40% of delirium cases are preventable.
The ideal is to be hospitalized in a facility that has already set up a multi-disciplinary delirium prevention approach, such as the Hospital Elder Life Program. Other hospitals have Acute Care for Elders units (also called “ACE” units) which also provide a special environment meant to minimize the hospital stressors that can tip an older person into delirium.
For elective surgeries, such as joint replacements, look for a hospital that has set up a geriatric co-management program for orthopedics, such as this one.
Here are some specific interventions that help reduce delirium, and how you can help as a caregiver:
- Minimize sleep deprivation. Consider asking the nurses if it’s possible to avoid blood pressure checks in the middle of the night. A quieter room can help. Do NOT ask for sleeping pills, however! Even a mild sedative, such as diphenhydramine (brand name Benadryl) increases the risk of developing delirium. Sleeping pills can also make delirium worse in someone who is already affected.
- Minimize vision and hearing impairments. Make sure the older person has glasses and hearing aids available, if they usually need them.
- Provide familiar objects and reassuring companionship. A few family photos can bring some soothing cheer to an older person’s hospital stay. Family or friends at bedside are also often very helpful, especially since they can help gently reorient an older person to where he is, and what’s been going on.
- Avoid overwhelming or overstimulating the person. Try to minimize mental strain or emotional stress for the person. A calm reassuring presence is ideal. If you need to give instructions or discuss something, try to keep things simple.
- Encourage physical activity and mobilization. Although many older people are sick or weak while in the hospital, it’s important to encourage safe activity as soon as possible. Physical therapy and minimizing bladder catheters (which can tether an older person to the bed) can help.
- Avoid sedatives and tranquilizers. Especially if the older person is restless or having difficulty sleeping, it’s not uncommon for sedatives such as diphenhydramine (brand name Benadryl) to be prescribed. But these can increase the risk of delirium, and should be avoided. So instead, try non-drug relaxation therapies such as soothing music, massage, a cup of tea, and familiar companionship.
- Minimize pain and discomforts. Ask the older person if he or she feels bothered by pain or constipation. If so, bring it up to the doctors. It’s not uncommon for pain to go inadequately treated unless family caregivers help an older patient bring it to the doctors’ attention.
If you think your loved one has developed delirium, make sure the doctors and nurses know about it. You may want to ask them what their plan is for evaluating and managing it. This will help you stay up-to-speed on the hospital course.
Some hospitals may even interview families to help diagnose delirium, using something called the FAM-CAM (short for Family Confusion Assessment Method) tool. The Confusion Assessment Method is generally considered the gold standard for diagnosing delirium.
Common causes of hospital delirium
Here are some common causes and triggers of hospital delirium and of “sundowning” symptoms when an older person is in the hospital. (Remember: in most older adults, multiple underlying causes and triggers are present.)
- Blood electrolyte imbalances (e.g. blood sodium being too high or too low)
- Infections, such as pneumonia, sepsis (bacteria in the bloodstream), and urinary tract infections
- General anesthesia and/or surgery
- Dehydration
- Drug toxicities and medication side-effects
- Withdrawal from alcohol, sedatives, or other drugs
- Blood glucose being too high or too low
- Sleep deprivation
- Kidney or liver problems
- Untreated pain or constipation
In people who have Alzheimer’s or another form of dementia, just the stress and unfamiliarity of the hospital setting can be enough to tip them into increased confusion.
Sensory impairments, such as uncorrected vision or hearing, can also help tip a vulnerable older person into delirium.
How hospital delirium is treated
To treat delirium, here’s what the doctors and nurses usually do:
- Identify and reverse as many triggers as possible. Remember, delirium is often multi-factorial. So even if there is a urinary tract infection that seems to have brought it on, the hospital team should try to spot any other factors that could be contributing (such as a medication side-effect, or a lack of glasses).
- Provide supportive care. It’s especially important to provide a calm restorative environment when a person is suffering from delirium. People may do better if they can avoid frequent room changes, and if they have a window allowing orientation to daylight.
- Prevent injury and manage difficult behaviors. This can be very challenging in those patients who become restless when delirious. Some hospitals have special “delirium rooms,” in which trained staff provide non-drug management of disoriented patients. As a last resort, the doctors do sometimes use low doses of medication. Research suggests that a small dose of antipsychotic, such as Haldol, is generally better than using a benzodiazepine (such as Ativan) which is more likely to make an older person’s confusion worse.
What you can do if an older person becomes delirious in the hospital
It can be scary to see an older person confused in the hospital, especially if you know that delirium can have serious consequences.
First and foremost, try not to panic. It’s time to hope for the best. Focus on doing what you can to help the delirium resolve.
As a family caregiver, you can play a very important role in providing a supportive and reassuring presence during an older person’s delirium. You can also:
- Advocate for minimum disruptions, and a quieter more pleasant room if possible.
- Make sure glasses and hearing aids are available, if needed.
- Help your loved one speak up if you think pain or constipation may be a problem.
- Question things if the hospital staff want to physically restrain the older person in bed. (This is a Choosing Wisely recommendation.) In many cases, if a person is dangerously restless, it’s better to start by trying a low dose of anti-psychotic, as mentioned above. Physically restraining a person often increases agitation and can lead to injury.
If you are of the really vigilant and proactive type, you may want to double-check that your loved one isn’t getting any sedatives or anticholinergic medications that make confusion worse. Even though these medications are risky for hospitalized older adults, it’s not uncommon for them to be prescribed!
What to expect after delirium: Even when all the right things are done — including getting the person home to a restful familiar environment — it often still takes a while for delirium to get better. In fact, it’s pretty common for it to take weeks — or even months — for delirium to completely resolve in an older adult. In some cases, the person never recovers back to their prior normal.
For more on delirium, see:
- 10 Things to Know About Delirium (includes information on delirium vs. dementia)
- Delirium: How Caregivers Can Protect People With Alzheimer’s (includes a list of helpful online resources that I’ve reviewed)
- A Common Problem That Speeds Alzheimer’s Decline, and How to Avoid It
You can also listen to our podcast episode, featuring leading delirium researcher Dr. Sharon Inouye, the founder of the Hospital Elder Life Program:
062 – Interview: Preventing Hospital Delirium & Maintaining Brain Health
This article was first published in 2014, and was last updated by Dr. K in March 2024.
Smudgie says
My 81 year old father had surgery for spinal stenosis 12 days ago. He was discharged from hospital into “step down care” a week ago and has been going downhill since then. The past 3 days he has been showing signs of delirium – last night he thought there was a mad person on the loose in the hospital (i got to the root of this – a woman in the room across from him was in a bad way and moaning and shouting and his mind clearly ran away with him. Once i explained what was going on he was back to normal) I went this morning and he told me that he spent the night locked in the basement and covered in water… when i tried to explain to him that he must have been dreaming he got quite aggressive about it. The doctor says he’s refusing to do his physio and when i tried to talk to him about it he claims that he’s fine and doesn’t need it. He also told me that i need to learn to listen to him otherwise i’ll ruin my life (!!).
He has had previous post op delirium after a knee replacement about 4 years ago so i guess this was not wholly unexpected but i didn’t realise it could take over a week to start. He does have an infection of some sort (they suspect UTI) for which he’s getting IV antibiotics so i’m hoping that once this clears the delirium will go away. Any thoughts around this would be appreciated as i’m hoping this stops soon, i’m actually scared to go and see him as it’s so nerve wracking not knowing what you’re going to be faced with.
I feel for the previous poster EJ as my father is a very difficult selfish person even when he is himself – so much so that we think he’s actually a sociopath. In his current condition he’s very hard to deal with and i believe the last time it happened (i was overseas at the time) he said some terrible things to my mother which upset her to the extent that she never really got over it (she passed away 2 years ago) so i think that sometimes when people are challenging in their normal state that the delirium accentuates this and brings out their dark side.
All he wants to do is come home and won’t listen to reason and threatens to discharge himself. I have a home nurse on standby for when he is discharged and i’m hoping that once he is out of the step down clinic things will improve.
Leslie Kernisan, MD MPH says
Sorry to hear of your father’s condition. Yes, delirium can start several days after surgery, for a variety of reasons, including a new infection as may be the case for your dad.
And yes, it can be very stressful to visit someone who is confused or saying upsetting things. If possible, try to remind yourself that this is the illness and not really his fault. (Even if he has a difficult personality, that is probably not his fault; such personalities are usually due to difficult childhoods or genetics or both.) It probably is good for him to have familiar people visit, but if possible, try to avoid arguing or trying to reason, and instead just try to be soothing.
This is of course very taxing, so get some help and support before and after these visits! I hope he improves soon. Good luck!
Smudgie says
Thank you. He was discharged from the step down facility day before yesterday and came home (I had home care set up). He wasn’t in great shape but the doctor had said he was fine to go home as the infection was clearing. Yesterday afternoon I had to call an ambulance as he had deteriorated to such an extent and he has been readmitted to hospital with pneumonia and a severe UTI / kidney infection among other worrying test results. I think the delirium must be related to the infection as he thought he was in hospital for his knee operation (which he had 4 years ago).
So we are back in square 1. Poor dad.
Leslie Kernisan, MD MPH says
Yes, if he has infections that is very likely a major contributor to his delirium. Hope he gets better soon!
Cher says
My mother is 94 and was diagnosed with mild Alzheimer’s 2 years ago. She wasn’t dealing well with living in her condo so she eventually agreed she would be better in a retirement home. Seven years ago she had surgery for stage 3 colon cancer and spent 3 weeks in respite care before going home. After getting home she entered a anxious depressed state (retrospectively may have been delirium). She eventually recovered after about 4 months.
Mom had been doing quite well in the retirement home but her appetite has been declining for some time. This winter I was sick a lot and wasn’t able to visit her very much although we spoke on the phone almost daily. Unfortunately she caught influenza in April, then fell a couple of times, then caught pneumonia. This resulted in several doctor and ER visits. Each time they sent her home even though she was very ill. Her dementia, weakness and appetite declined significantly. We took her out for dinner and to our home for dinner to try and boost her spirits and get her to eat when possible.
About 2 weeks ago I got a call from staff at Mom’s retirement home saying she was very ill, confused and could not figure out how to get dressed. With her agreement we sent her by ambulance to,the ER. They indicated that pneumonia was still present and put her on IV with antibiotics. Her dementia worsened and she was considered to have delirium. She has been in the hospital ever since and is very weak, not eating and needs lots of help with toileting. This is a barrier to her return to her independent living retirement home. My mom doesn’t know she is in the hospital, although we keep telling her she is. We have also tried to encourage her to eat with limited success. She did seem to be improving but after a conversation with a medical professional in her presence about her delirium, etc she has gone down hill, despite our daily visits and having a visit with our daughter and her 16 month great grandson.
She can’t remember where she was living previously, and although I think being there again might help, she can’t go back until she can dress and toilet herself. The options are moving her to an enhanced care retirement home for a short period in till either she can return home or be placed in a a nursing home. The cost of enhanced care would eat through her money very quickly and I am concerned about moving her more than once which even if she recovered from the delirium might set her back. The waiting lists for long term care homes in our area are quite long (up to 5 years), with the less desirable ones having shorter wait times.
Regardless she is sleeping a lot again, is very subdued, can barely keep her eyes open when we visit and is eating less and less. I am wondering whether she can recover or realistically if we should be prepared for the worst. I am her only child and it is very difficult to determine how best to support her.
Leslie Kernisan, MD MPH says
Sorry that your mother has been so sick recently. I can certainly see why you’re concerned.
In terms of can she recover and what’s realistic to expect. At this point, she’s been unwell since April, so about 2 months. At her age, the longer one is sick, the weaker one gets and the longer it takes to recover. One is also very vulnerable to getting sick again easily, which it sounds like she’s done.
Could she recover? It’s still possible but even under the best more health-supporting circumstances (e.g. in a familiar low-stress environment with lots of loving support and minimum toxic healthcare exposures), it would probably take her months to slowly recover. I have only occasionally seen people her age recover, mainly under two types of circumstances. The first is when the older person goes home and has devoted family with a lot of time available to take care of them. (This is not feasible for more families to provide.)
The other type of circumstance that sometimes helps older adults heal is, paradoxically, to enroll in hospice. Why? Because hospice tends to bring lots of supportive services and attention to symptoms, and hospice de-emphasizes the type of medical care that in principle can extend life but in practice is often quite toxic to frail older adults.
(I explain hospice, esp for dementia, in this article: Hospice in Dementia, Medications, & What to Do If You’re Concerned.)
I don’t suppose you previously had a chance to talk to her about what she’d want to prioritize, if she were quite sick and it was unclear whether she’d recover?
If she’s still in the hospital, another option you can consider is to request a palliative care consultation. They should be able to help you think through the “big picture” of her situation, and your options.
Hope for the best, prepare for the likely and quite possible. I think you are doing all the right things. She is sick but you are making an effort to be present and to advocate for her, that’s what’s most important. Good luck and take care.
Sinead says
My nan went into hospital for a routine infusion for her arthritis I believe. Half way through it was stopped as she began feeling ill.
The following day in hospital she started having delirium. She was sharp of mind beforehand. The first week she was able to reflect on these extreme episodes, which tended to start in the evening but she has gradually gotten worse and is current mumbling away and not sleeping.
Last week she was able to identify everyone in a photo album.
A few days ago we were not able to wake her and discovered the hospital had increased the anti psychotic drug. She was rushed away for an hour and deemed critical although the following day she didn’t seem too bad.
The hospital said that they couldn’t find any infection. Then they diagnosed her (4.5 weeks later) with delirium and masked dementia after testing where she scored 13 out of 30. We did not agree with the dementia diagnoses.
A few days later they were suggesting to test for a brain infection through a lumber puncture. The latest diagnoses is scarring to the brain. She had a brain scan a few weeks ago and this wasn’t mentioned.
We wanted to take her home last week but we’re told it’s not possible. The hospital are pushing for us to put her into a dementia home. Before hospital admittance there was nothing wrong with her mind.
Please give me some advice
Writing from Ireland
Leslie Kernisan, MD MPH says
Sorry to hear of your situation and sorry for delayed reply (some of the comments were misdirected in the system and so I’m finding them quite late, argh!)
As I’ve mentioned in previous responses, if her mind seemed pretty good before her illness, that improves her chances of eventually recovering. But, the recovery can take quite a long time.
I do find that being home is often better, but helping an older person recover from delirium can be very labor intensive for family and not everyone is able to provide the necessary care.
I hope at this point that she’s gotten better. Good luck and take care.
E.J. says
My mother was admitted to the hospital with pneumonia the beginning of this past month and just after her release, she was still having difficulty breathing. She’s had COPD since I was 9 then diagnosed with emphysema in 2014. I’m 43 now. She’s76. I got an urgent call to the ICU-she went into acute respiratory distress they had put her on a ventilator, intubated her, restraints in a medically-induced coma for 5 days. Her blood ox was 72%. Since then she has been belligerent, absolutely cruel going after everything from my divorce to my physical appearance. She’s now vilifying my boyfriend using vulgar language at me. The nursing staff actually winced at some of what she said to me and faked that visiting hours were over so I could have an “out. Mom was diagnosed with histrionic personality disorder and cyclothymia when I was 9 or 10 and it wasn’t until my father died 3 years ago that I realized how much he ran interference for us so she’s already predisposed to some negative antics. I love my mom and I’m the only child since my brother’s death. We’re the only family we have left. Tonight I was going to bring some clothing items she requested to the rehab facility they just transferred her to and she called me a bunch of expletives then hung up on me. It wasn’t the first time. I sent her a text saying that I was a person with feelings too and as long as she was going to curse at me and hang up on me I could not continue to do this tonight because my nerves are fried. She does have hearing aids but hers are not working and I have been looking all over the house for the little box containing the spares and I didn’t realize till I read your site how frustrating that must be for her. I sent her a text saying that I was a person with feelings too and as long as she was going to curse at me and hang up on me I cannot do this tonight because my nerves are fried. I lost a house to foreclosure in April, in March I had to have a tenant arrested for getting physically aggressive with me, in May I was involved in an auto accident that put me in the hospital for 12 days which prevented me from going to my storage space to reclaim my belongings and I lost over 20 years of my property because they disposed of it. So I’m under a lot of stress and she is sharp enough to use these experiences along with the failed marriage almost 4 years ago (he upgraded didn’t he?) to berate me further. I just wondered if there’s a correlation between viciousness and reactions to hospital delirium or how much she really is out of it and if it could be from the oxygen deprivation she suffered be for being put on the ventilator. Sorry this is so long I am guilting myself for not rushing over there with familiar things and photographs as recommended but she just decimated me tonight and I really needed a break. She never responded to my text except with a sarcastic Mother’s Day meme of her own. So slowly destroying me. Being a caregiver for my dad who was 21 years older was nothing like this Alzheimer’s and all. He got cranky but not vindictive. Am I alone in this?
Leslie Kernisan, MD MPH says
Yikes, sounds like both you and your mom have been through a lot!
No, you are definitely not the only person to be struggling to help an older parent who says very hurtful things.
You should definitely take a break and protect yourself when it feels needed. Try to not feel guilty. Join an online caregiving community (this one is quite active) for moral support and encouragement on taking care of yourself during this difficult time.
Yes, you want to help your mother, but my general take is that no person should have to risk significant harm or emotional hurt to help an older parent.
If she has a difficult personality or is prone to wound you, then you’ll have to find ways to help and care while still maintaining some healthy boundaries. A very good book on how to do this is “Coping With Your Difficult Older Parent: A guide for stressed-out children.”
In terms of the correlation between delirium and viciousness: both delirium and dementia can cause “disinhibition”, meaning people end up saying or blurting out all these inappropriate things that they previously knew better than to say. So some people can become more of their negative self. In other cases, people’s personalities seem to change quite a lot, with previously mild and kind individuals behaving very differently than before.
If your mother has always been “difficult”, then this is probably delirium making her worse than usual. I would still recommend the book on Coping with Your Difficult Older Parent, since you will likely be in some type of caregiving/support role for the rest of your mother’s life.
I also highly recommend finding a support community. (The online ones are convenient if you’re busy.) Don’t attempt this alone, it is too hard and you need to connect with others. You will see that you are not the only one going through this. You’ll get ideas on how to cope and reminders to take care of yourself, so I can’t recommend support groups enough. Good luck!
Lynda says
Is buspar an appropriate medication for dilirium? My father is better during the day taking little naps but becomes more vocal and is not sleeping at night. Two nights ago he did great but then was up all of last night yelling help and trying to pull his catheter out. They had started him on the buspar medication a couple of days ago as well as melatonin. Thanks for you help.
Leslie Kernisan, MD MPH says
Buspirone is a medication for anxiety. It is not a benzodiazepine or typical “tranquilizing” kind of drug.
I’m not aware of any recommendations that it be used for delirium or agitation. I myself don’t prescribe it very often.
Some people do experience agitation or insomnia with this medication, so you may want to ask your father’s doctors if he might be responding badly to the medication. Otherwise, it is common for older adults to develop more confusion in the afternoons, in part because that’s when people tend to get tired.
Good luck, I hope your father starts feeling better soon.
Shonda I Moon says
MY mother has just had bypass surgery at 65. She had 5 bypasses. She was on a ventilator for up to 3 days after surgery and on day four became very paranolid that the hospital staff were trying to poison her. This is day nine and she is still waxing and waning. She does know who we are but is unable to speak very clearly. She seems very confused and unable to rest. Please send any information that would help us to better help her.
Leslie Kernisan, MD MPH says
Sorry to hear of your mother’s condition. All the information and resources I have are listed in the article above.
Basically, your mom’s healthcare team needs to keep checking for delirium triggers and contributors (infection, pain, constipation, dehydration, medication side-effects, electrolyte imbalances). And then she otherwise needs supportive care so that her brain dysfunction can resolve. So she needs rest but also exposure to daylight, some physical mobilization if possible, her glasses and hearing aids if applicable, and reassurance. The presence and involvement of family members often helps provide this type of support and reassurance.
I hope she feels better soon.
Rina says
My 94 year old mother has survived the flu, pneumonia, and pulmonary edema and is now home still suffering from delirium. She was prescribed Seroquel and 37.5 mg at night and 12.5 mg during the day as needed. I don’t see a too much improvement in a little over a week and am wondering how long she can safely be on this drug. Is the drug meant to slow her revved up mind enough so her brain can heal and she can eventually be weaned off of it? Thank you for your time.
Leslie Kernisan, MD MPH says
Sorry to hear that your mother has been delirious.
Quetiapine (brand name Seroquel) is an “atypical” antipsychotic. It is not FDA-approved to treat delirium but is sometimes used when a person is quite agitated and nothing else is working. Studies have found that antipsychotics can improve symptoms somewhat, but I’m not aware of any studies that have examined the value of an older person continuing the antipsychotic after hospital discharge.
In a 2017 JAMA paper on delirium in older adults, the summary states:
“Current recommendations for pharmacologic treatment of delirium, based on recent reviews of the evidence, recommend reserving use of antipsychotics and other sedating medications for treatment of severe agitation that poses risk to patient or staff safety or threatens interruption of essential medical therapies.”
We do know that it can take months for an older person’s delirium to resolve; I once saw a patient in his early 90s slowly improve over a full year.
In terms of whether your mother is likely to benefit from continuing Seroquel: we don’t know what the effect is on prolonged delirium, but we do know that older adults who are on antipsychotics have a higher risk of stroke and death.
I don’t know that there is any evidence that antipsychotics calm a revved mind in a way that helps it heal. They certainly are sedating, which reduces agitation and may be reducing stress levels.
I would encourage you to talk to your mother’s doctors about the antipsychotic. A general rule of thumb in geriatrics is that we want people to be on the least medication that is necessary, and we should only continue medication if it seems quite clear that the benefits outweigh the risks. Since the long-term benefits of continuing the antipsychotic are unknown, it would probably be reasonable to slowly taper it down and see how your mom does. Try to address any agitation or restlessness with non-drug methods, like soothing company, fresh air, a restful environment, and so forth.
You may find it helpful to read this article on medications for difficult dementia behaviors (delirium can cause similar behaviors), since it covers antipsychotics and also non-drug ways to mitigate behavior: 5 Types of Medication Used to Treat Difficult Dementia Behaviors.
Good luck, I hope she gets better soon.
Angela B says
I just wanted to thank you for this article.
My mother is 67 and lived independently. She even worked part time. She got a kidney stone which resulted in an infected kidney. The infection became septic and she ended up hospitalized in ICU. They decided to remove the kidney as she wasn’t responding to the antibiotics. After two weeks in ICU, she was finally well enough to go to a regular ward.
Only I noticed that she seemed very confused. She struggles for words, she “remembers” things that have not happened, and was hallucinating.
After reading this article I was able to articulate my concerns to the doctor as well as make changes myself to help her. It’s only been a couple of days but since then I believe she is making improvements. She has a long way to go but I am more hopeful.
Thanks again!
Loura says
Hello I was wondering if you have noticed abnormal moaning when in pain or not for the elderly suffering from delerium. Thank you.
Leslie Kernisan, MD MPH says
Yes, some older adults who are delirious will moan, as an expression of pain or discomfort or distress.
Moaning is pretty non-specific, though. (meaning, it can come up in lots of situations!) If you are concerned that an older person has delirium, the main symptoms are having difficulty paying attention and/or more confusion than usual, and it has to be a change from the person’s baseline mental state.
Evaluating for causes of moaning is very important in that we always want to recognize and try to address pain or distress. Any form of pain, constipation, fear, or other distress can be a contributor to delirium. Hope this helps.
Anaya says
My mother was in hospital for 7 days to cure Hyponatremia. Her sodium was dropped to 100 due to wrongly prescribed medicine.
She was doing ok mentally when one day she went into a space of fear chills sweat and stayed there for an hour or so. It started in last 2 days at hospital.
Ee brought her home and giving her best possible care but she is so weak that she can’t walk even with a cane. We use wheelchair to take her to bathroom.
When she sleeps ad wakes up (even after 5 minutes) she feels better, talk to us, stand with help or eat with her hand but like after 20 min she again goes to this confusion state and doesn’t come back unless she sleeps. It’s been 3 days she is back from hospital and we are extremelly worried she might not come back. She has hypertension and diabetes.
Leslie Kernisan, MD MPH says
Well, 3 days is not a long time since she was back, it takes many people weeks or longer to significantly improve. She probably needs a lot of rest, it sounds like she gets mentally worse as soon as she moves around or is active for more than 20 minutes.
That said, if her sodium was recently low, you may want to ask her doctors if there’s any possibility it could be low again. That in of itself can cause confusion. Good luck, I hope she starts feeling better soon.