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What is delirium?

Submitted by Emma Hamilton on Fri, 17/10/2008 - 3:47pm

Delirium is a serious medical condition causing acute confusion. 

People with delirium experience changes in cognition such as disorientation, agitation and delusions. Unlike dementia, symptoms of delirium occur suddenly. 

People with delirium can be drowsy, irritable or appear different to their normal selves. Insomnia and night-time disturbance are also common symptoms of delirium. A person with delirium can appear frightened, angry or have difficulty paying attention.

Symptoms can often fluctuate during the day. It can last a few days or weeks and if left untreated can lead to serious medical complications. 

 

What causes delirium?

Delirium can have many causes. Older people can be more susceptible to delirium due to multiple physical illnesses, over the counter drugs, and even stressful situations. Many older people experience  delirium after surgery or during a hospital stay.

Delirium can be caused by:

  • Infection 
  • Pain
  • Medications
  • Electrolyte disturbance
  • Surgery
  • Withdrawal from alcohol
  • Dehydration

Delirium can also co-exist with dementia and be difficult to tell apart. Unfortunately sudden changes in behaviour or confusion can be overlooked in people with dementia and mistaken for a natural progression of dementia. 

As a carer you will be a valuable resource for your doctor as changes may be subtle and confounded by dementia.
 
A simple urinary tract infection (UTI) can cause delirium along with chest infections, head injury and changes in blood glucose levels.  
 

 

Treating delirium 

If the person you care for shows any sudden changes in mood, memory or orientation see your doctor immediately. Treatment of delirium will depend on the underlying cause.
 
A doctor may order a number of blood or urine tests, look at any medications a person is taking or take a mental status assessment. Assessment of delirium could also involve other investigations including xrays and brain scans. 
 
 

Caring for someone with delirium

If you are caring for someone with delirium they will need extra support and care. Pay particular attention to the environment. Try and keep the person in a familiar environment by avoiding moving a person too much.

It can be comforting for people experiencing delirium to see familiar faces and friends especially if the person is in hospital. 

If a family member is in hospital with delirium it may help to organise extra care such as hiring a nurse for an overnight stay. Older people with delirium are more at risk of falls and will need special monitoring. It can help to remove objects from the bed side if the person is agitated and use soft night lights for orientation. 

Things you can try:

  • Talk clearly and slowly.
  • Ensure the person gets adequate food and fluids.
  • Orientate the person to their environment. Remind them where they are, what time of day it is and who you are.  
  • Diminish distracting loud noises such as radio and television.
  • Ensure a person has their comfort items such as familiar blankets, photos and favourite music or clothing.
  • Check the person is wearing hearing aids and glasses.
  • Protect the person from falls and dangerous objects.
  • Do not restrain a person.
  • Try placing a mattress on the floor for night time waking. 
  • Discourage day time sleeping. 

 

Related articles

 

References

The AGS foundation for Health in Aging
Delirium (sudden confusion)
Accessed 2008

 

2 comments

Emma Hamilton wrote 1 year 19 weeks ago Aged care nurse
Thanks for your comments Jean. It can be easy associate a change in behaviour to progression of dementia but it is not always the case. Delirium unfortunately does often go undetected. There are many causes of delirium or sudden confusion (not just UTI) including medications that can cause night disturbance and delusions. Standard cognitive tests for dementia could be misinterpreted and useless due to her poor vision and hearing. I would pursue the staff for further investigations possibly by a visiting psychogeriatric nurse or psychogeriatrician. Even a Home Medicine Review by a pharmacist (most nursing homes do this with a doctor's permission) could find something. The Dementia Behaviour Management Advisory Service can give you some help and advice on 1800 699 799.
Jean Waddell wrote 1 year 20 weeks ago
My mother is 84, in high, nursing home care and has episodes of 'delirium'. First it was blamed on UTI's but recently mum had an episode that I witnessed, the UTI test came up clear and so the staff said mum was demented. I strongly oppose this because mum could relate her delusions and said she was finding it harder to come out of 'her fairyland' as she calls it. If she can recall her experience and recent family events she is not demented in my view. Her nursing home medical staff consists of one doctor and one RN at least 25 patients. There are no psychiatrists or the like on staff so how is a diagnosis made under such conditions and how reliable is it. Mum is blind to the point where she can only see colour and shape on a large TV screen and she so profoundly deaf she is now finding it difficult to hear with through headphones for radio or TV. I mention this because I feel the memory test to diagnose dementia is useless to such disabilities. I have found your site very informative and now feel confident to talk to her doctor about my views.

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