Delirium

Delirium – Information for patients, families and Friends

It is our hope that this article will help you learn more about:

What is Delirium?

The signs and symptoms
How it can be prevented and
What families, friends and caregivers can do to help
Where to find more information

What is Delirium?

Delirium is a condition that causes a person to be confused. It is a physical problem (a change in the body) that can cause temporary change in the person’s thinking. Delirium usually starts over a few days and often get better with treatment.

Delirium can happen to anyone, anywhere. But, it often happens when someone is in the Hospital

Once identified, delirium is often treated as a medical emergency. Treatment is put in place right away because it can be a risk to patient safety.

Delirium can cause patients to slip and fall or to feel a lot of emotional and spiritual distress. A person with delirium may not be able to understand when people are trying to help them. They may become angry with family and hospital staff. They may start to think that everyone is against them or are trying to harm them. Some people with delirium may want to call the police to get help.

Delirium is like being in the middle of a very strange dream or nightmare, but the person is having these experiences while they are fully awake.

What is the risk of delirium?

About 20 out of 100 patients admitted to hospital will experience.
About 70 patients out of 100 admitted to the intensive care unit will experience delirium.

What causes delirium?

Delirium can be caused by:

A Physical illness (that brought someone to the hospital)

Someone who is ill can have changes in their body chemicals, become dehydrated (not enough water in the body) or get an infection, such as a bladder infect or urinary tract infection. These kinds of problems can cause delirium.

Medications

The medications the hospitals use to treat illness or control pain can cause delirium

Is delirium the same as depression or dementia?

No. Delirium can happen more often in people who have dementia or depression, but it is different.

Delirium happens quickly. It can come and go at any time. This does happen with dementia and depression.

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

Types of Delirium

There are 2 types of delirium:

Hypoactive delirium

This type of delirium happens most often in elderly patients but can affect anyone at any age.

Patients with hypoactive delirium may:

Move very slowly or not active
Not want to spend time with others
Pause frequently when speaking or not speak at all
Look sleepy

Hyperactive delirium

This type of delirium is easier to recognize.

Patients with hyperactive delirium may:

May be worried and afraid
Be restless (not able to stay still or have trouble sleeping)
Repeat the same movement 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 hypoactive and hyperactive symptoms.

What are the signs and symptoms of delirium?

A check list:

Disorganized thinking YES NO

Saying things that are mixed up or do not make sense

Difficulty concentrating YES NO

Easily distracted or having difficulty following what is being said

Memory changes YES NO

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

Hallucinations YES NO

Seeing or hearing things which are not real

Having delusions YES NO

Thinking or believing things which are not true or real

Feeling restless . YES NO

Not able to stay still, trouble sleeping, getting out of bed

Changing energy levels YES NO

Changes from being restless to being drowsy or sleepier than usual

How can delirium be prevented?

All patients should be carefully screened (checked) for these factors that may cause delirium:

Hearing problems
Vision problems
Not enough water in the body (dehydration)
Not being able to sleep or other sleep problems
Dementia, depression or both
Difficulty getting up and walking around
Medication being taken
History of alcohol or recreational drug use
Chemical changes or imbalances in your body
Low oxygen in your body
Other health condition or illness

Having trouble:

Thinking clearly, reasoning, remembering and judging
Concentrating
Understanding
Express ideas

How is delirium be treated?

The health care team helps the patient stay safe and calm

They will try to find the cause of the delirium. Often, there is more than one cause. They also make sure any factors they find are not caused by another medical condition

Then they will address the factors or ease the symptoms.

This could include:

Reviewing and changing medications
Provide fluids to rehydrate
Correcting chemical problems in the body
Treat infections
Treating low oxygen levels

What can family and friends do to help?

Family and friends and caregivers can all help to prevent delirium for their loved ones in hospital.

Keep a careful watch for the signs and symptoms of delirium

If you see any signs that could mean delirium talk with your health care team right away. Family members are often the first to notice these small changes.
Use the signs and symptoms check list and factors list listed on this article to guide your findings.

Help with healthy eating and drinking while at the hospital

Ask what is right for your loved one before they eat and drink.
Make sure they have their dentures (if needed).
Encourage help with eating. Feel free to bring their favourite foods from home, check with the health care team about foods they should not eat.
Encourage them to drink often, if that is right for them.

Keep track of medications

Share a complete list of their prescriptions and any over the counter medications they take with the health care team… including the dosage.

Help with activity

Ask what is right for your loved one before starting any activities.
Talk to the team about helpful and safe activities.
Help them sit, stand and walk.

Help with mental stimulation

Make a schedule for family and friends to visit. This will help your loved one feel safe and comforted.
Speak to them in a calm, reassuring voice.
Tell them where they are and why they are there throughout the day. If possible, place a large sign in their room or write information on it.
For example, you could write: Today’s date, weather, where they are and their room number… this will help them stay connected.
Give them instructions one at a time. Do not give too much information at once.
Bring a few familiar objects from home, such as photo albums and their favourite music. If your loved one needs special care to prevent the spread of infection, check with the care team first.
Open the curtains during the day time.
Talk about current events.
Read the newspaper out loud or use talking books

Help them with eyesight and hearing

Make sure they wear their hearing aids or glasses, if they need them.
Make sure there is enough light in the room.
Help them use a magnifying glass, if they need one.

Help them rest and sleep

Reduce noise and distraction.
Soothe them with handholding, a massage, a warm drink or music.
Bring a night light, but check with the health care team first.
Use comfort items like their favourite pillow and blanket.
Limit the number of visitors who come to see your loved one until the delirium goes away.
The health care team may not give your loved one sleeping medications because it could make delirium worse.

Take care of yourself

It is not easy to be with a person with delirium, even though you may understand the problem

Make sure to look after yourself and get some rest. Go out for short walks, remember to eat and drink fluids to keep up your energy levels.
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 may say during their delirium state. People with delirium are not themselves. In many cases, they will not remember what they said or did.

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

There are many members of the health care team who can offer help and support. Talk with your doctor or nurse and any member of the health care team, including a Psychiatry, Spiritual Care or Social Work departments. They will answer any questions or concerns you may have about delirium.

Delirium should go away or be greatly reduced with the right kinds of treatment… although in some cases some of the symptoms may remain for an extended period of time.