Many older people admitted to hospital experience delirium. Delirium is characterised by a sudden onset of confusion, delusions, sleep disturbance and hallucinations.
It has many causes but is often triggered by infection, medications or surgery. Left untreated delirium can have serious medical consequences. Watching a loved one with delirium can be very distressing.
Unlike dementia, symptoms of delirium happen suddenly. A person experiencing delirium will normally present either in a highly agitated state or be lethargic and unaware of their surroundings.
Some people with delirium will swing between the two states. Symptoms can be noticeable within a few hours, come and go and quickly progress.
For people living with dementia, delirium can cause a rapid progression of dementia which they may not recover.
Symptoms of delirium include:
• A sudden onset of confusion
• Sleep disturbance
• Hallucinations (seeing or hearing things that aren’t there)
• Unusually lethargic, mumbled speech or uncommunicative
• Restless, angry outbursts or mood swings
• Poor appetite
• Poor concentration and alertness, may come and go
• Slower movements, falls
If you’re caring for a family member admitted to hospital be aware of the signs of delirium. Symptoms may go unnoticed by busy staff or be attributed to dementia.
As a caregiver you have an intimate knowledge of your loved one’s normal mental state. If they don’t appear to be their usual self, let medical staff know.
Older people hospitalised with delirium can find the experience terrifying. A simple change in environment and unfamiliar faces can have a damaging affect on a person’s emotional and physical wellbeing.
People with delirium can wander at night, have angry outbursts and are highly susceptible to falls. Their condition can quickly deteriorate. When a person is difficult to rouse, ensuring they get adequate food and fluids can be a challenge.
Watching a loved one with delirium can be frightening for the whole family. Sadly delirium often causes a cascade of medical events that can lead to nursing home care.
What you can do:
Treatment of delirium involves treating any underlying medical condition associated with delirium and ceasing drugs that exacerbate or lead to delirium.
Inform medical staff of current health conditions and medications.
Medical staff need to know as much about your loved one’s underlying medical condition as possible. What medications are they taking? Have they recently commenced a new drug or ceased a drug? Are they taking their medications as prescribed?
Be alert to any changes in thinking or behaviour.
Medical staff should ask you what is your loved one’s usual mental state. You will know if a loved one is not their normal self. Even if they’re usually confused, they may exhibit behaviours or say things out of character for them.
Having a familiar face around can be reasurring for a person experiencing delirium. If a loved one is in hospital and suffers from delirium you could find yourself providing extra comfort and care during their stay.
Visit the hospital as much as you can.
A change in environment can be detrimental for someone with dementia, especially when they are unwell. A familiar face by the bedside can ease anxiety. Be there for meal times to ensure your loved one gets adequate food and fluids. Ensure they are well hydrated.
Provide reassurance, orientation and comfort.
Be there to explain procedures and remind a person where they are and why. Give simple explanations that provide comfort. Try and be present during a procedure. It’s not unusual for catheters and intravenous lines to be pulled out by a patient with delirium.
Keep glasses, hearing aids and dentures handy.
Too often older people are mistaken for being more disorientated than they are when hearing aids and glasses are not fitted. These items are often put away for safety during a hospital visit.
Maintain a calm familiar environment, encourage sleep when needed.
A family member may have to sleep by the bedside to reduce night time agitation and wandering. Sedation should be avoided.You may like to bring in familiar items to the hospital like photos, a favourite blanket, items or games to play together. Too many visitors could be confusing for someone highly agitated.
Encourage some gentle activity, limit restraints.
If a loved one is agitated they may benefit from a short walk or change of scenery. Mobilise a person where you can. They will need supervision and assistance if they’re at risk of falls. Walking to and from the toilet can be enough. Ensure they are not restrained.