Delirium is a confused mental state that causes disorientation (confusion). It starts suddenly and can come and go. It is common in older people and people with other health conditions.
- Symptoms include quickly changing mental states, problems with attention, awareness, thinking, memory, feelings or sleep.
- It usually has an underlying cause. Many people make a full recovery once this has been treated.
- Risk factors include being over 65 years old, having dementia, a hip fracture or severe illness, and being elderly and in hospital.
- Getting help early limits its longer-term effects.
What causes delirium?
Delirium is caused by:
- infections, especially, of the bladder (UTI), chest or skin
- medication, especially if several types are being used
- surgery or serious injury, including broken bones
- heavy alcohol use or withdrawal
- diabetes that is not well controlled
- heart, kidney or liver failure
- dehydration, lack of sleep or constipation
- unrelieved pain or stress.
What are the symptoms of delirium?
Sudden and new symptoms of:
- not being aware of the correct time and place
- poor concentration and short-term memory
- a disturbed sleep-wake cycle, including sleeping in the day
- hallucinations (seeing or hearing things that aren’t there) or delusions (false beliefs)
- being upset, confused or anxious
- being withdrawn and drowsy
- an unsteady walk or a tremor
- loss of bowel or bladder control.
How is delirium diagnosed?
Your doctor will want to find out the underlying cause of your delirium, so will ask about your symptoms and your medical history, as well as do a physical examination and blood tests.
How is delirium treated?
If you have mild symptoms you will receive treatment at home for the underlying cause of the delirium. If you have severe delirium, you may be admitted to hospital and receive medication.
Self-help for delirium
The following may help you or someone you are caring for with delirium:
- reminders of the time or day, such as clocks and calendars
- making sure hearing aids and glasses are nearby
- moderate light, noise and temperature levels
- plenty of rest and no over-stimulation
- enough sleep, healthy food, water, movement and regular use of the toilet.
Can delirium be prevented?
The PINCHES ME Kindly approach can be useful to help avoid delirium in elderly and sick people:
- Pain: manage
- Infection avoid
- Nutrition: good
- Constipation: avoid
- Hydration: plenty
- Exercise: appropriate
- Sleep: regular
- Medication: only as necessary
- Environment: quiet, sight and hearing aids
'Kindly' refers to the need to be supportive and compassionate.
Image: Think Delirium prevention project: PINCHES ME Kindly Canterbury District Health Board
Delirium in older adults Health in ageing
Holden J, Jayathissa S, Young G. Delirium among elderly general medical patients in a New Zealand hospital. Internal Medicine Journal. 2008. 38(8):629-634.
Young J, Inouye SK. Delirium in older people. BMJ (Clinical research ed.). 2007. 334(7598):842-846.
Delirium (Acute Confusion): Information for patients, families and friendsCarers New Zealand.