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Recognizing and responding to delirium

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Delirium is a type of confusion that occurs suddenly and without warning. When people have delirium, they may have trouble focusing or paying attention. They also may feel groggy and drowsy, or act or say things out of character. Delirium can be a warning signal that someone is not feeling well.

It’s important to recognize delirium because it may signal an underlying problem. An infection may be starting, like a urinary tract infection, or something else that needs medical attention. It is important to seek help when you notice these signs.

 

Delirium risk factors

Certain factors increase the risk of experiencing delirium. Any decline in thinking or memory increases the risk of delirium. People who have multiple chronic illnesses, like diabetes and sleep apnea, are at a higher risk. Older adults with dementia are at a higher risk, but it can affect people of all ages. Some children also experience delirium during critical illness and when waking up from anesthesia.

 

Signs and symptoms of delirium

People who develop delirium may act abnormally and feel more drowsy or sleepy than usual. They have trouble focusing or are easily distracted. They may ask you to repeat what you said multiple times or appear not to have heard you.

Sometimes in delirium, people may not remember the date, time, where they are or why they are in that location. They may recall memories from the past or appear to see or hear things that are not present. They may not recognize familiar faces and be agitated and restless.

Any of these signs are signs of delirium that require medical attention. Delirium symptoms can come and go, lasting for a little while or a long while.

 

Delirium in the hospital

Being hospitalized is a risk factor for delirium. The hospital can be an unfamiliar or scary place for some people, especially loved ones who have memory problems, are older or have existing health problems.

For example, a loved one can be hospitalized for a heart attack, but then develop delirium. This increases the risk for other problems while in the hospital, including an infection or a fall, leading to a longer hospital stay.

Family and friends may notice quicker if their loved ones are not acting like themselves. The health care team may be meeting patients for the first time and may not know them as well as close friends and relatives. If your loved one starts to show signs of delirium, it’s important to alert the health care team.

 

How to help

You can take steps if you notice that loved ones are showing signs of delirium. Reassure them so they know they are safe. Remind them of the time, date, where they are located and what is going on. This is called “reorientation.”

You can distract and stimulate their brains by talking with them, telling stories or reminiscing over favorite memories. It may be helpful to show them familiar photos or bring familiar objects like a favorite pillow or books.

If glasses or hearing aids are used at home, bring these items to the hospital. Keeping someone’s sleep-wake routine is important. Being active during the day with physical activity and conversation, and then sleeping at night will help. Things to help sleep include a hot beverage before bedtime, earplugs or eye masks, soothing music or a back rub.

Heidi Lindroth, Ph.D., R.N.

Dr. Lindroth is a nurse scientist and practicing critical care nurse passionate about improving the care of hospitalized older adults at Mayo Clinic in Rochester, Minnesota.

Margaret Paulson, D.O.

Dr. Paulson is the chief clinical officer for advanced care at home at Mayo Clinic Health System, Northwest Wisconsin Region.

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