Delirium

Delirium

Information for patients, family and friends. This text will help you to learn more about: What delirium is, its signs and symptoms, how can it be treated, how family and friends can help, where to find more information or resources.

What is delirium?

Delirium (dih-leer-ee-uhm) is a condition which causes a person to become confused in their thinking. It is a physical problem (a change in the body), not a psychological one (change in how the mind works).

Delirium usually starts over a few days and will often improve with treatment.

Delirium happens more often in those who already have dementia or depression, but it is different in these ways:

Delirium happens quickly and then can disappear. It can come and go at any time. This does not happen with dementia and depression.

Patients with delirium cannot focus their attention. This is different from patients with dementia or depression.

There are two types of delirium:

1. Hypoactive delirium happens most often in elderly patients. These patients are often mistaken for having depression or a form of dementia.

Patients with hypoactive delirium may:

• Move very slowly or not be active
• Not want to spend time with others
• Hesitate when speaking or not speak at all.

2. Hyperactive delirium is easier to recognize.

Patients with hyperactive delirium can:

• Be worried or afraid
• Be restless (not able to stay still or have trouble sleeping
• Repeat the same movements many times
• Experience hallucinations (seeing something or someone that is not really there)
• Experience delusions (believe something that is not true)
• At times, a patient can have both hyperactive and hypoactive symptoms.

What causes delirium?

Delirium can be caused by:

• A physical illness: Changes to body chemicals, dehydration (lack of water) or an infection, such as a urinary tract infection, could cause someone who is ill to become delirious.
• Medications: Some medicines used to treat illness or control pain may cause delirium.

Remember: Anyone can become delirious when ill.

What are the signs and symptoms of delirium? Here come common symptoms and signs:

Disorganized thinking: Saying things that are mixed up or do not make sense

Difficulty concentrating: Easily distracted or having difficulty following what is being said

Memory changes: Not able to remember names, places, dates, times or other important information

Hallucinating: Seeing or hearing things which are not real

Having delusions: Thinking or believing things which are not true or real

Feeling restless: Not able to stay still, trouble sleeping, climbing out of bed

Changing energy levels: Changes from being restless to being drowsy or sleepier than usual.

Other things to know about delirium

A person with delirium may not be able to understand when people are trying to help them. They may become irritated (angry) with hospital staff and family. They may start to think that everyone is against the, or are trying to harm them. Some delirious people may want to call the police to get help.

Delirium is like being in the middle of a very strange dream or nightmare. The difference is that the person with delirium is having these experiences while they are awake.

Can delirium be prevented? Illustration by Elena.

How can delirium be prevented?

Medicine has focus on patient safety preventing delirium from happening to any patient.

Doctors carefully screen (check) patients for factors that may cause delirium. They then address these factors early to help prevent it. These factors include:

• Hearing problems
• Vision problems
• Not enough water in the body (dehydration)
• Not being able to sleep or other sleep problems
• Dementia, depression or both
• Having trouble in thinking clearly – reasoning, remembering, judging; concentrating, understanding, expressing ideas
• Difficulty getting up and walking around
• The medications being taken
• History of alcohol or recreational drug use
• Chemical changes or imbalances in your body
• Low oxygen in your body
• Other health conditions or illnesses.

 How is delirium treated?

• The healthcare teams at hospital will create a safe environment for the patient and help them stay calm.
• They will look into the cause of the delirium based on the screening factors and symptoms. Many times, there is no single cause.
• They will then address the factors and symptoms. This could include: reviewing and changing medications, providing fluids, correcting chemical problems in the body, treating infections, treating low oxygen levels.

What can family and friends do to help?

Patients, family and friends can all help to prevent delirium. There are also many things that family members and friends can do to help someone who has delirium:

• Talk with the health care team about any signs of delirium you see developing in your loved one. Use the signs and symptoms described above to help you.
• Make sure your loved one always has their hearing aid, dentures, and glasses close by, if needed.
• Use a calm, soft voice speaking to your loved one or when speaking with others in the room.
• Place a soft light in the room at night so that your loved one will always know where they are. Before bringing in any electrical items, check with the healthcare team first. Keep the window curtains open to help your loved one know if it is daytime or nighttime.
• Remind your loved one where they are, what time it is, the date and the season. If possible, place a large sign in their room or write this information on a whiteboard. For example, you could write: “Today is Thursday, January 22, 2015. You are at Toronto General Hospital.” This will help them to stay connected.
• Gently reassure them that they are safe.
• Encourage your loved one to drink fluids, but check with the healthcare team first if they have any fluid restrictions. Feel free to bring their favourite foods from home, but check first with the health care team about any foods they should not eat.
• Make up a schedule of family and close friends who will stay with your loved one day and night so they will not be alone. This will help them feel more secure, less frightened and calm.
• Bring familiar photos into the room or play familiar music softly in the background.
• Limit the number of visitors who come to see your loved one until the delirium goes away.
• Make sure to look after yourself and get some rest and relaxation. Go out for short walks, remember to eat, and drink fluids to keep up your energy level.
• It is not easy to be with a delirious person, even though you may understand the problem. It may help to share your thoughts and feelings with someone. Feel free to speak with the health care team.
• Try not to become upset about the things your loved one with delirium may say. Delirious people are not themselves. In many cases, they will not remember what they said or did while delirious.

Preventing delirium in the hospital: Clocks and calendars may help patients stay oriented.

With the right kinds of treatments, the delirium should go away or be greatly reduced.

There are many healthcare professionals who can support and help you during this time. Please feel free to speak with your doctor or nurse and any other member of the team, including the Psychiatry service, spiritual care of social work.

Who can I talk to if I have more questions or any concerns?

The healthcare team can answer any questions or concerns you have about delirium. Many helpful websites, articles, books can help you find more information about delirium.

With the right kinds of treatments, the delirium should go away or be greatly reduced. Illustration: Megan Jorgensen.