Delirium
About this leaflet
You may find this leaflet helpful if you have experienced delirium, know someone with delirium or are caring for someone with delirium.
What is delirium?
Delirium is a state of confusion that can happen if you become unwell. It is also known as an “acute confusional state.”
Approximately 2 in 10 hospital patients have a period of delirium. Severe illness, surgery and medications can cause delirium. It usually starts suddenly and can last several days, weeks or Months.
It can be frightening – for the person who is unwell and those around them.
What is it like to have delirium?
A person with delirium may:
- Be less aware of what is going on around them
- Be unsure of who they are or where they are
- Be unable to have a meaningful conversation
- Have poor attention, concentration and memory
- Hear or see things which are not there
- Worry that others are trying to harm them
- Be very agitated or restless
- Be very slow or sleepy
- Have moods which change very quickly
A patient’s description of severe delirium
Frances was in hospital following a heart bypass. She had never heard of delirium.
"I had terrible hallucinations. Other patients were not in their beds, they were in pop-up cars. There were people dressed as ninjas at each side of the bed. I asked my family to take me home. It was worse for my family knowing I was so unhappy. It would be reassuring for families to know that it is actually a condition and it's not just happening to you.”
What causes delirium?
There are many causes of delirium, including:
- Urine and chest infections
- Side effects of medicines e.g. pain killers, steroids
- Major surgery
- Alcohol
- Suddenly stopping drugs
- Pain
- Dehydration
- Constipation
- Too much or too little oxygen
- Being in an unfamiliar place
- Terminal illness
It is more common in people who:
- Are over 65 years old
- Have memory problems, poor eyesight or hearing
- Have recently had surgery
- Have a severe illness
How can I help someone with delirium?
- Stay calm, listen and offer reassurance
- Use simple sentences, check that they have understood you and repeat things if necessary
- Make sure that someone they know well is with them
- Help them to eat and drink
- Remind them of where they are and the time and date. If possible make sure they can see a clock or calendar
- Ensure they have their glasses and hearing aid/s
- Bring in some familiar objects from home
- Have a light on at night so they can see where they are
How is delirium treated?
- If someone becomes suddenly confused, they need to see a doctor urgently
- Report delirium, so the cause can be found and treated
Can sedative medication help?
Sedative medication can make delirium worse. It should be used only in certain circumstances in low doses for the shortest time possible:
- To calm someone to have investigations or treatment
- To stop someone endangering themselves or others
- When someone is very anxious or agitated
- When someone is hearing or seeing things that are not there
- When someone who drinks a lot of alcohol stops suddenly
How long does it take to get better?
- Delirium gets better when the cause is treated. One can recover quickly, but it can take several days, weeks or in some cases months
- Once somebody has recovered from delirium, they may have unpleasant or frightening memories or they may not remember what happened at all
- If somebody has had delirium in the past, they are more likely to have delirium again if they become medically unwell
- Watch out for sudden changes in behaviour and report delirium, so the cause can be found and treated
Further information
If the delirium has not resolved or you are finding it difficult to cope, please contact your GP, local walk in-centre, or the local A&E.
NICE CG103 Delirium – July 2010
A government issued NHS clinical continuing care guidelines
Mind
A mental health charity for England and Wales
European Delirium Association
An organization for health professionals and scientists involved with delirium. The website also has links to other sites with information on delirium for patients and carers
www.europeandeliriumassociation.com
Acknowledgements
The Royal College of Psychiatry