Delirium
Delirium
Overview
Delirium (acute confusional state) is when someone’s mental function has a sudden change. It comes on quickly, often over hours or days.
As well as showing confusion, people with delirium can be sleepy, agitated, have altered beliefs or see hallucinations.
Delirium is often triggered by:
- illness
- the side affects of medication
- an injury
- having surgery
What is the difference between delirium and dementia?
Delirium comes on over hours or days and, in most cases, it will get better in a few days. Dementia develops over months or years and is nearly always irreversible.
Delirium and dementia symptoms can sometimes overlap, for example disorientation is usual in both conditions. However people with delirium are more likely to:
- be drowsy
- be agitated
- be paranoid
- have hallucinations
The 2 conditions often co-exist, especially in older people. People with dementia are much more likely to develop delirium. In hospital at least half of older people with delirium will also have dementia.
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Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
Causes of delirium
Delirium is caused by a change in the way the brain functions. There are many things that can trigger this, including:
- an infection – including urinary tract infections (UTIs) and chest infections
- prescription medicine – delirium can be a side effect or an effect of sudden withdrawal
- dehydration
- constipation
- injuries (for example hip fractures)
- low blood sugar level, for example in people with diabetes
- alcohol withdrawal
- surgery
- severe psychological stress
Increased risk of delirium
Anyone can get delirium but some things can increase the risk, including:
- being over 65
- having dementia
- being frail
- hearing or sight loss
- having had delirium before
- alcohol misuse
Delirium is one of the most common medical emergencies. It’s found in around 1 in 7 adults in hospital and about half of patients in intensive care.
Diagnosis
Family members and caregivers are usually the ones who notice delirium first, because they know the person's normal mental state and can spot when something changes.
Doctors and nurses confirm delirium by checking for its core symptoms, often using a short test called the 4AT (short for "4 A's test"). During this test, a healthcare professional asks a few simple orientation questions, such as what year it is. They may also ask the person to say the months of the year backwards.
These questions help show whether the person's mental function is different from how it normally is.
Treatment
Delirium usually happens because of one or more underlying triggers, so treatment starts with figuring out what these are. Once identified, healthcare professionals can treat them as effectively as possible. For example, if the person has a chest infection, treating that infection would also help ease the delirium.
Often, more than one trigger is involved. A person with a chest infection may also be dehydrated or have low blood oxygen levels, and both of these could be triggering the delirium or making it worse.
Complications
After the danger has passed and symptoms are under control, the focus shifts to helping the person recover. The goal is to get them back to their normal self, and this happens through rehabilitation, spending time with them, keeping them hydrated, and making sure they eat well.
Complications of delirium
Delirium can sometimes lead to problems such as:
- reduced mobility
- falls
- pressure sores on the skin
- a sense of isolation
How to support someone with delirium
If you are caring for someone with delirium, a few things can make a real difference:
- keep hearing aids, glasses and dentures close at hand so they can use them
- be gentle and warm in how you approach them, smile, and offer reassurance
- speak to them and keep them informed using short, simple sentences
- try to have someone familiar to them stay by their side
- keep a calendar or clock, or both, somewhere they can see it easily
- bring a few familiar items from home to place near their bed, such as family photographs
- if it is safe, help them eat and drink, and check with the care staff first if you are unsure
Looking after someone with delirium can take a toll on you too. Make sure you are still sleeping and eating properly, and try to build a support network around you rather than managing everything alone.
What is the long term impact of having delirium?
Recovering from delirium can leave a person at higher risk of developing dementia later on. For those already living with dementia, an episode of delirium can leave them worse off than before.
Some people who go through a distressing episode of delirium may later develop symptoms similar to post traumatic stress, such as intrusive memories of what happened, along with anxiety and low mood.
Delirium when someone is dying
Delirium is very common in the last days of a person's life, affecting as many as half of people at this stage.
It still matters to recognise the delirium and check whether there are any triggers that can be easily treated. That said, the main focus of care at this point is on managing the symptoms and keeping the person comfortable.
Read more about what happens when someone is dying.