What is delirium

In those with serious illnesses, delirium may lead to the following complications:. The best way to prevent delirium is to be aware of the risk factors and mitigate them through proactive measures such as the following:.

Below are some of the physical examinations and tests that might be done when conducting an assessment for delirium:. In addition, a mental status test would be conducted.

For example, the Confusion Assessment Method involves observing whether a patient can speak, think, and move normally and whether their behavior changes throughout the day.

Treatment depends on the cause of the delirium. If a person is not already hospitalized, a hospital stay may become necessary. Certain medications will need to be stopped e. Finally, basic assistive devices such as eyeglasses or hearing aids may help those with impairments. Medications may be given to manage the underlying cause of delirium. Full recovery from delirium is possible depending on the underlying cause and how well it is treated. It may take a patient several weeks to fully recover from delirium.

How do you know if your loved one should be seen by a doctor? Or what do you do if your loved one is already in the hospital and you are concerned that they may be experiencing delirium?

First, recognize that older people enduring hospital stays are most at risk for delirium. If your loved one is in the hospital and showing the signs and symptoms listed above, it's important not to assume that the hospital staff or medical staff have noticed this change. You will need to tell doctors about the changes that you are seeing from normal functioning and how you see a someone acting differently.

It may help for you to keep a record or log of events as they happen so that you can explain what you are seeing and also how it changes over time. A record of your observations will allow the hospital staff to intervene as necessary.

If, on the other hand, you have a loved one or relative who is not in the hospital and is showing signs of delirium, it is important to help that person visit the doctor for an assessment or, if symptoms are severe, you may need to take them to the emergency department for immediate help. Delirium is a treatable acute condition that is most common among older individuals and those who have been hospitalized. The best thing you can do is to familiarize yourself with the signs and symptoms of delirium so that you can be aware of what to look for when visiting loved ones who are older or in the hospital.

While it may be scary to experience delirium or to witness someone else experiencing it, know that a full recovery is possible with appropriate treatment. For this reason, it's best that delirium is caught as early as possible.

If you notice the signs and symptoms in a loved one, it's better to act on them quickly rather than to let the situation extend. The longer your loved one experiences symptoms, the more time it will take for them to make a full recovery.

Learn the best ways to manage stress and negativity in your life. Psychology Today. Setters B, Solberg LM. Prim Care. Delirium in elderly people. Your Privacy Rights. To change or withdraw your consent choices for VerywellMind. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page.

These choices will be signaled globally to our partners and will not affect browsing data. We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes.

There are many different problems that can cause delirium. Some of the more common causes include. The symptoms of delirium usually start suddenly, over a few hours or a few days. They often come and go. The most common symptoms include. Delirium and dementia have similar symptoms, so it can be hard to tell them apart. They can also occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse and can last for hours or weeks.

On the other hand, dementia develops slowly and does not cause hallucinations. The symptoms are stable and may last for months or years. Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery.

Any stress due to a drug, disorder, or situation that causes the level of acetylcholine to further decrease can make it harder for the brain to function. Thus, in older people, such stresses are particularly likely to cause delirium.

Other conditions: Older people are also more likely to have other conditions that make them more susceptible to delirium, such as the following:.

Delirium is often the first sign of another, sometimes serious disorder. Confusion, the most obvious symptom, may be harder to recognize in older people. Younger people with delirium may be agitated, but very old people tend to become quiet and withdrawn.

In such cases, recognizing delirium is even harder. If psychotic behavior develops in older people, it usually indicates delirium or dementia. Psychosis due to a psychiatric disorder rarely begins during old age. Older people are more likely to have dementia, which makes delirium harder to identify. Both cause confusion. Doctors also ask the person a series of questions that test various aspects of thinking mental status examination Mental Status When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system.

Examination of the nervous system—the Doctors usually treat people whose mental function suddenly worsens—even if they have dementia—as if they have delirium until proved otherwise. Having dementia increases the risk of developing delirium, and some people have both. Delirium and the hospitalization it usually requires can cause many other problems, such as undernutrition Undernutrition Undernutrition is a deficiency of calories or of one or more essential nutrients.

Undernutrition may develop because people cannot obtain or prepare food, have a disorder that makes eating or Pressure sores often result from pressure combined with pulling on the skin, friction, These problems may have serious consequences in older people. Thus, older people can benefit from treatment managed by an interdisciplinary team Interdisciplinary care Providing medical care to older people can be complicated. People often have many different health care practitioners at different locations.

Travel and transportation issues become more difficult To help prevent delirium in an older person during a hospital stay, family members can ask hospital staff members to help—by doing the following:. Family members can visit and talk with the person and thus help keep the person oriented. People with delirium may be frightened, and the familiar voice of a family member can have a calming effect.

Delirium usually begins suddenly and progresses over hours or days. The actions of people with delirium vary but roughly resemble those of a person who is becoming progressively more intoxicated. People with delirium cannot concentrate, so they have trouble processing new information and cannot recall recent events.

Thus, they do not understand what is happening around them. They become disoriented. Sudden confusion about time and often about place where they are may be an early sign of delirium. If delirium is severe, people may not know who they or other people are. Thinking is confused, and people with delirium ramble, sometimes becoming incoherent.

Their level of awareness consciousness may fluctuate. That is, people may be overly alert one moment and drowsy and sluggish the next.

Other symptoms also often change within minutes and tend to worsen during the evening a phenomenon called sundowning. People with delirium often sleep restlessly or reverse their sleep-wake cycle, sleeping during the day and staying awake at night.

People may have bizarre, frightening visual hallucinations, seeing things or people that are not there. Some people develop paranoia unwarranted feelings of being persecuted or have delusions false beliefs usually involving a misinterpretation of perceptions or experiences.

Personality and mood may change. Some people become so quiet and withdrawn that no one notices that they are delirious. Others become irritable, agitated, and restless and may pace. People who develop delirium after taking sedatives are likely to become very drowsy and withdrawn. Those who have taken amphetamines or who have stopped taking sedatives may become aggressive and hyperactive.

Some people alternate between the two types of behavior. Delirium can last hours, days, or even longer, depending on the severity and the cause. If the cause of delirium is not quickly identified and treated, people may become increasingly drowsy and unresponsive, requiring vigorous stimulation to be aroused a condition called stupor Stupor and Coma Stupor is unresponsiveness from which a person can be aroused only by vigorous, physical stimulation.

Coma is unresponsiveness from which a person cannot be aroused and in which the person's Stupor may lead to coma or death. Doctors suspect delirium based on symptoms, particularly when people cannot pay attention and when their ability to pay attention fluctuates from one moment to the next. However, mild delirium may be difficult to recognize. Doctors may not recognize delirium in hospitalized people. Most people thought to have delirium are hospitalized to evaluate them and protect them from injuring themselves or others.

Diagnostic procedures can be done quickly and safely in the hospital, and any disorders detected can be treated quickly. Because delirium may be caused by a serious disorder which could be rapidly fatal , doctors try to identify the cause as quickly as possible. Treating the cause, once identified, can often reverse the delirium. Doctors first try to distinguish delirium from other disorders that affect mental function.

Friends, family members, or other observers are asked for information because people with delirium are usually unable to answer. Questions include the following:. What drugs including alcohol and illicit drugs, especially if the person is younger and dietary supplements including medicinal herbs the person uses.

Information may also come from medical records, the police, emergency medical personnel, or evidence such as pill bottles and certain documents. Documents such as a checkbook, recent letters, or notification of unpaid bills or missed appointments can indicate a change in mental function. If delirium is accompanied by agitation and hallucinations, delusions, or paranoia, it must be distinguished from a psychosis due to a psychiatric disorder, such as manic-depressive illness Bipolar Disorder In bipolar disorder formerly called manic-depressive illness , episodes of depression alternate with episodes of mania or a less severe form of mania called hypomania.

Mania is characterized People with a psychosis due to a psychiatric disorder do not have confusion or memory loss, and the level of consciousness does not change. Psychotic behavior that begins during old age usually indicates delirium or dementia. During the physical examination, doctors check for signs of disorders that can cause delirium, such as infections and dehydration. A neurologic examination Neurologic Examination When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system.

People who may have delirium are given a mental status test Mental Status When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system.

First, they are asked questions to determine whether the main problem is being unable to pay attention. For example, they are read a short list and asked to repeat it. Doctors must determine whether people take in register what is read to them. People with delirium cannot. The mental status test also includes other questions and tasks, such as testing short-term and long-term memory, naming objects, writing sentences, and copying shapes. People with delirium may be too confused, agitated, or withdrawn to respond to this test.

Samples of blood and urine are usually taken and analyzed to check for disorders that doctors think may be causing delirium. For example, abnormalities in electrolyte and blood sugar levels and liver and kidney disorders are common causes of delirium.

So doctors usually do blood tests to measure electrolyte and blood sugar levels and to evaluate how well the liver and kidneys are functioning. If doctors suspect a thyroid disorder, tests may be done to evaluate how well the thyroid gland is functioning. Or if doctors suspect that certain drugs may be the cause, they may do tests to measure drug levels in the blood.

These tests can help determine whether drug levels are high enough to have harmful effects and whether a person took an overdose. Cultures Culture of Microorganisms Infectious diseases are caused by microorganisms, such as bacteria, viruses, fungi, and parasites. Doctors suspect an infection based on the person's symptoms, physical examination results, A chest x-ray may be done to determine whether pneumonia may be the cause of delirium, especially in older people who are breathing fast, whether or not they have a fever or cough.

Sometimes a test that records the brain's electrical activity electroencephalography Electroencephalography Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography EEG is a simple, painless procedure in which Electrocardiography ECG , pulse oximetry using a sensor that measures oxygen levels in the blood , and a chest x-ray may be used to evaluate how well the heart and lungs are functioning.

In people with a fever or headache, a spinal tap Spinal Tap Spinal fluid is a liquid that surrounds your brain and spinal cord. Spinal fluid helps cushion your brain if you hit your head or fall. Spinal fluid moves freely around your brain and spinal Such analysis helps doctors rule out infection of or bleeding around the brain and spinal cord as possible causes.

Most people who have delirium are hospitalized. However, when the cause of delirium can be corrected readily for example, when the cause is low blood sugar , people are observed for a short time in the emergency department and can then return home. Once the cause is identified, it is promptly corrected or treated.

For example, doctors treat infections with antibiotics, dehydration with fluids and electrolytes given intravenously, and delirium due to stopping alcohol with benzodiazepines as well as measures to help people not start drinking alcohol again.

Prompt treatment of the disorder causing delirium usually prevents permanent brain damage and may result in a complete recovery. The environment is kept as quiet and calm as possible. It should be well-lit to enable people to recognize what and who is in their room and where they are.

Placing clocks, calendars, and family photographs in the room can help with orientation. At every opportunity, staff and family members should reassure people and remind them of the time and place.

Procedures should be explained before and as they are done. People who need glasses or hearing aids should have access to them. People who have delirium are prone to many problems, including dehydration Dehydration Dehydration is a deficiency of water in the body.