“How should delirium be managed in the hospital?”
This question came up during a Q & A session, as we were discussing the Choosing Wisely recommendation to avoid tying down older adults who become confused during a hospitalization.
Delirium is a common and very important problem for all older adults in the hospital. It doesn’t just happen to people with Alzheimer’s or a dementia diagnosis. (And, it’s not the same thing.)
But many family caregivers have hardly heard of hospital delirium. This is too bad, since there’s a lot that family caregivers can do to prevent this serious complication, or at least prevent an older loved one from being physically restrained if delirium does occur.
In this post, I’ll review what older adults and families absolutely should know about hospital delirium. And, we’ll cover some of the things you can do if it happens to your loved one.
Why hospital delirium is so important to know about
Delirium is a state of worse-than-usual mental function, brought on by illness or some kind of stress on the body or mind.
Although people with dementia are especially prone to develop delirium, delirium can and does affect many aging adults who don’t have Alzheimer’s or another dementia diagnosis. Here are some facts that all older adults and family caregivers should know:
- Delirium is very common during hospitalization. Delirium can affect up to half of older patients in a hospital. Risk factors include having pre-existing dementia and undergoing surgery. Having had delirium in the past is also a strong risk factor.
- Delirium is strongly associated with worse health outcomes. Short-term problems linked to delirium include falls and longer hospital stays. Longer-term consequences can include speeding up cognitive decline, and a higher chance of dying within the following year.
- Delirium is often missed by hospital staff. Busy hospital staff may not realize that an older person is more confused than usual, especially if the delirium is of the “quiet” type. (Although many people are restless when delirious, it’s also common for people to become quiet and “spaced out.”)
- Delirium is multifactorial. There often isn’t a single cause for delirium. Instead, it tends to happen due to a combination of triggers (illness, pain, medication side-effects) and risk factors (dementia, or pre-dementia). This means that treatment — and prevention — often require a multi-pronged approach.
To summarize, delirium is common, serious, and often missed by hospital staff.
Fortunately, there’s a lot that you can do as a family caregiver. In particular, you can help your loved one more safely get through a hospitalization by:
- Taking steps to prevent delirium;
- Keeping an eye out for any new or worse-than-usual mental states that might signal delirium;
- Making sure hospital staff address the problem if it does happen;
- Questioning things if the hospital resorts to tying a person down, before all other options have been tried. (This last one is a Choosing Wisely recommendation.)
How to prevent hospital delirium
Now, not all hospital delirium can be prevented. Some people are very sick, or very prone to delirium, and it’s certainly possible to develop delirium even when all triggers and risk factors have been addressed. Furthermore, many older adults are already delirious when they first get hospitalized.
Still, there are steps that can be taken to reduce the chance of a bad delirium. Experts estimate that about 40% of delirium cases are preventable.
The ideal is to be hospitalized in a facility that has already set up a multi-disciplinary delirium prevention approach, such as the Hospital Elder Life Program. Other hospitals have Acute Care for Elders units (also called “ACE” units) which also provide a special environment meant to minimize the hospital stressors that can tip an older person into delirium.
For elective surgeries, such as joint replacements, look for a hospital that has set up a geriatric co-management program for orthopedics, such as this one.
Here are some specific interventions that help reduce delirium, and how you can help as a caregiver:
- Minimize sleep deprivation. Consider asking the nurses if it’s possible to avoid blood pressure checks in the middle of the night. A quieter room can help. Do NOT ask for sleeping pills, however! Even a mild sedative, such as diphenhydramine (brand name Benadryl) increases the risk of developing delirium. Sleeping pills can also make delirium worse in someone who is already affected.
- Minimize vision and hearing impairments. Make sure the older person has glasses and hearing aids available, if they usually need them.
- Provide familiar objects and reassuring companionship. A few family photos can bring some soothing cheer to an older person’s hospital stay. Family or friends at bedside are also often very helpful, especially since they can help gently reorient an older person to where he is, and what’s been going on.
- Avoid overwhelming or overstimulating the person. Try to minimize mental strain or emotional stress for the person. A calm reassuring presence is ideal. If you need to give instructions or discuss something, try to keep things simple.
- Encourage physical activity and mobilization. Although many older people are sick or weak while in the hospital, it’s important to encourage safe activity as soon as possible. Physical therapy and minimizing bladder catheters (which can tether an older person to the bed) can help.
- Avoid sedatives and tranquilizers. Especially if the older person is restless or having difficulty sleeping, it’s not uncommon for sedatives such as diphenhydramine (brand name Benadryl) to be prescribed. But these can increase the risk of delirium, and should be avoided. So instead, try non-drug relaxation therapies such as soothing music, massage, a cup of tea, and familiar companionship.
- Minimize pain and discomforts. Ask the older person if he or she feels bothered by pain or constipation. If so, bring it up to the doctors. It’s not uncommon for pain to go inadequately treated unless family caregivers help an older patient bring it to the doctors’ attention.
For more useful ideas, see this family tip sheet from the Hospital Elder Life Program.
If you think your loved one has developed delirium, make sure the doctors and nurses know about it. You may want to ask them what their plan is for evaluating and managing it. This will help you stay up-to-speed on the hospital course.
Some hospitals may even interview families to help diagnose delirium, using something called the FAM-CAM (short for Family Confusion Assessment Method) tool. The Confusion Assessment Method is generally considered the gold standard for diagnosing delirium.
How hospital delirium is treated
To treat delirium, here’s what the doctors and nurses usually do:
- Identify and reverse as many triggers as possible. Remember, delirium is often multi-factorial. So even if there is a urinary tract infection that seems to have brought it on, the hospital team should try to spot any other factors that could be contributing (such as a medication side-effect, or a lack of glasses).
- Provide supportive care. It’s especially important to provide a calm restorative environment when a person is suffering from delirium. People may do better if they can avoid frequent room changes, and if they have a window allowing orientation to daylight.
- Prevent injury and manage difficult behaviors. This can be very challenging in those patients who become restless when delirious. Some hospitals have special “delirium rooms,” in which trained staff provide non-drug management of disoriented patients. As a last resort, the doctors do sometimes use low doses of medication. Research suggests that a small dose of antipsychotic, such as Haldol, is generally better than using a benzodiazepine (such as Ativan) which is more likely to make an older person’s confusion worse.
What you can do if an older person becomes delirious in the hospital
It can be scary to see an older person confused in the hospital, especially if you know that delirium can have serious consequences.
First and foremost, try not to panic. It’s time to hope for the best. Focus on doing what you can to help the delirium resolve.
As a family caregiver, you can play a very important role in providing a supportive and reassuring presence during an older person’s delirium. You can also:
- Advocate for minimum disruptions, and a quieter more pleasant room if possible.
- Make sure glasses and hearing aids are available, if needed.
- Help your loved one speak up if you think pain or constipation may be a problem.
- Question things if the hospital staff want to physically restrain the older person in bed. (This is a Choosing Wisely recommendation.) In many cases, if a person is dangerously restless, it’s better to start by trying a low dose of anti-psychotic, as mentioned above. Physically restraining a person often increases agitation and can lead to injury.
If you are of the really vigilant and proactive type, you may want to double-check that your loved one isn’t getting any sedatives or anticholinergic medications that make confusion worse. Even though these medications are risky for hospitalized older adults, it’s not uncommon for them to be prescribed!
What to expect after delirium: Even when all the right things are done — including getting the person home to a restful familiar environment — it often still takes a while for delirium to get better. In fact, it’s pretty common for it to take weeks — or even months — for delirium to completely resolve in an older adult. In some cases, the person never recovers back to their prior normal.
For more on delirium, see:
- 10 Things to Know About Delirium (includes information on delirium vs. dementia)
- Delirium: How Caregivers Can Protect People With Alzheimer’s (includes a list of helpful online resources that I’ve reviewed)
- A Common Problem That Speeds Alzheimer’s Decline, and How to Avoid It
You can also listen to our podcast episode, featuring leading delirium researcher Dr. Sharon Inouye, the founder of the Hospital Elder Life Program:
062 – Interview: Preventing Hospital Delirium & Maintaining Brain Health
This article was first published in 2014, and was last updated by Dr. K in March 2022. As we are now at 200+ comments, the comments section has been closed to new comments. Thank you!
It is possible for younger people to suffer from this complication. My son, almost 50, has had two episodes I now understand. Doctors and nursing staff did not discuss this fully and tended to focus on alcohol use in a rather accusatory manner.
It would have been far more helpful to my son and his family if they had been more informative rather than moralistic and punitive.
Yes, it’s quite true that delirium can affect younger adults. Withdrawal from alcohol or other substances is one of the more common causes of delirium in younger adults, but it can also be caused by bad infections or other illnesses. I’m sorry to hear the hospital staff seemed to judgmental; no patient and family deserves that.
My father is recovering from spine surgery that took place two days ago and about 24 hours ago he has been showing signs of delirium. The doctors have perform CT scans and all bloodwork has come back showing no sign of a cause to his confusion. The doctors are leaning towards late alcohol withdrawals as to the onset of the confusion. I am wondering if the withdrawls are the trigger or if the confusion/ deliurium state go hand in hand. My father is currently in the ICU and we are doing what ever necessary to keep him less confused and to hopefully see him recover. He is 65 and active and i wanted to know about recovery and possible outcomes that we hopefully will not have to experience.
On its own, the stress of surgery often causes delirium in older adults, and confusion is a very common symptom in delirium. But doctors should never assume that a recent surgery is the ONLY factor causing or worsening delirium, so it’s good that the doctors are investigating and trying to identify all possible triggers and contributing factors. If your father usually drinks a fair-heavy amount most days, then he could indeed be experiencing alcohol withdrawal, and this is usually managed by providing benzodiazepines to keep the withdrawal symptoms from becoming dangerous. (Otherwise, we usually try to avoid benzodiazepines as they can make delirium worse.)
But he could well be also experiencing delirium due to post-operative pain, residual effects of anesthesia, and not getting enough sleep in the hospital. There is also always the possibility of infection, electrolyte imbalances, medication side-effects, and more.
In terms of recovery, it’s quite variable. The problems triggering/worsening the delirium usually need to be treated/removed, and then different people take differing amounts of time to recover. Some recover to their usual mental state very quickly, but it’s not uncommon for it to take weeks or longer for people to fully recover. At 65 your father is not very old, but if he is a chronic drinker then his brain may not be as resilient as it would otherwise be.
I go into more detail on recovery and possible outcomes in this article: 10 Things to Know About Delirium. Good luck!
My father recently had a total knee replacement, then was overmedicated with high doses of narcotics due to high pain levels also ended up back in the hospital (my step mother thought he was having a stroke due to slurred speech and drowsiness, but it was the meds). It took 3 days in the hospital off the natcotics for his delirium to subside. And I noticed in the hospital that the sleep deprivation made the delirium worse (nurse vitals checks and specialists coming in and out of the room). I had to be the dragon at the gate, had the MD talk to nursing to not disrupt sleep and push for a discharge from the hospital then all went much better. Post op pain disturbs sleep in already sleep-deprived seniors also. Good luck! Be a strong advocate for your loved one!
Thanks for sharing your story. Yes, sleep deprivation can certainly be a trigger or contributor to delirium.
Pain management after surgery can be tricky. High doses of opiates can certainly make older adults confused. However, uncontrolled pain can also be a trigger for delirium. It is often challenging for clinicians to correctly dose pain medication in order to avoid either of these problems.
I’m glad you were able to successfully advocate for your father, and hope he continues to improve.
Please note: HALDOL should NOT be used if a patient has Lewy Body Dementia! My Dad was treated with this at the hospital during his episode of Hospital Induced Delirium despite his diagnosed Lewy Body Dementia!
Yes this is true: haloperidol (brand name Haldol) should be avoided in people with Lewy Body dementia, Parkinson’s disease, or other conditions related to Parkinsonism.
This is because haloperidol and really most antipsychotics are strong dopamine blockers. People with Parkinson’s and Lewy-Body disease become very sensitive to low dopamine levels so they can experience serious side-effects when dopamine is blocked by antipsychotic medications.
The least dopamine-blocking antipsychotic is probably quetiapine (brand name Seroquel), so if an antipsychotic is absolutely necessary in someone with Lewy-Body, that’s a safer choice to try. The lowest dose possible should be used.
I know this article is a little old but desperate for answers. My sons fiance is 28 has cystic fibrosis lung transplant, liver transplant, diabetes, went into the hospital for a chest cold the over medicated her ended up in a coma then they called it unresponsive now they call it delirium. Last week she made huge improvements walking, sitting up, smiling recognizing people saying short words and trying to talk. Only for a week later now all she say s is no wants no one to touch her moans yells and is worse then she was at the beginning. Her parents have stayed with her but do not ask questions do not research my son is beside himself any help would be appreciated.
Sounds like an awful and stressful situation.
Honestly, your son’s fiance’s medical situation sounds quite particular and complicated. Younger adults can get delirium if they are very sick, and she certainly sounds like she could have been sick enough to become delirious despite being only 28.
However, there’s a long list of potential medical reasons why she might still have what we call an “altered mental status.” She has had organ transplants so usually that means she has to take immune-suppressing medication, and that makes people susceptible to all kinds of problems that would otherwise be unusual in someone her age.
Now, it’s certainly possible that something is being overlooked, or that her medical care is being optimally managed. And what is very common is for doctors to not explain things clearly to the family, which causes a lot of stress.
So if your son and his fiance’s family are very worried, the only thing I can think of would be to consider hiring a professional patient advocate, to help them understand what is going on. If they go this route, they should ask questions to make sure they hire someone who will be able to sort through a case that is this medically complicated.
Alternatively, they can try asking the doctors there a lot more questions, or perhaps asking for a second opinion from a doctor or consultant within the hospital system.
I hope your son’s fiance gets better soon. good luck!
My mom, 67, just had a leg amputation. Cognitively she was extremely sharp before entering the hospital. Now she said hearing voices, barely knows who we are, and now 3 weeks post surgery is pulling Agnes her own hair and slapping herself. All we hear isn’t acute delirium. I just don’t see how this could happen so suddenly and so hard. She seems worse than some people with advanced dementia. One day before entering the hospital we were having s normal conversation then like that she was gone (mentally). I never heard my mother curse and she’s always one to listen to authority figures and now she curses a lot and at nurses, doctors,us, and to imaginary people. I am distraught
Oh, this does sounds like a bad situation and must be very upsetting for your family.
I’m not sure why you would be told this isn’t delirium. If she was very cognitively sharp before the hospitalization, then delirium is by far the most common cause of the kind of symptoms you are describing. There are also other possibilities, such as strokes or rapidly progressive dementias, but they are MUCH less common.
She did just have a major surgery, which raises the question of whether her mental state is being aggravated by a complication such an infection of her wound. (Urinary tract infections or getting sick from something in the hospital/rehab facility are other possibilities.) It’s also quite possible that she’s having inadequately treated pain, or constipation, or is being set back by a medication side-effect, or dehydration, and so forth.
I would encourage you to keep asking her doctors lots of questions. Make sure they understand that she was cognitively fine before surgery, and if they tell you this probably is not delirium, push them to explain what they think is causing your mother’s behaviors. If they think it IS delirium, then you might want to ask what they are doing to try to identify and mitigate causes and contributors.
Many older adults like your mom do eventually get better with time, but it can be a very rough road in the early days and weeks. Good luck and keep us posted if you can.
This is really helpful information.
In my situation, the hospital staff are great and well aware of the delirium.
What I really want to know though is what to do in the moments when the person is experiencing delirium. Should I correct incorrect thinking and paranoia? It just seems to create more agitation so I’m not sure what to do.
Trying to correct a person’s delusions almost never works, and as you note, can create more agitation. Rather than trying to be right, you want to be reassuring, without relying on a logical explanation of why the delirious person shouldn’t be concerned. Try to help them feel heard — via active listening — and loved. The presence of familiar family and friends is often helpful, although it’s hard to see a loved one be delirious.
For more tips and resources, see 10 Things to Know About Delirium.
There are also excellent tips here: What you can do if your family member is delirious. Good luck!
Has anyone remember what they did and how there husband was with you when you were going through with delirium
If a person is experiencing delirium, he or she should seek medical care. Being in the disturbed state of mind would severely affect the way a person lives. It would be nice to provide enough and appropriate attention to the person suffering from such Be sure to have a constant communication with each other to avoid any unwanted situations.
My Grandad was admitted to hospital with delirium 4 weeks ago but in the last 2 weeks his behaviour has worsened, he’s almost unrecognisable to us. We are becoming increasingly frustrated with the treatment and care he’s receiving. Much of the advice above seems to be being ignored. Before the hospitalisation he was living independently, we know he will never return home but we need to get him out we just don’t know how and where to?
Oh, that’s a tough situation. It is unfortunately common for families to feel frustrated with hospital staff, who sometimes are too busy to do a good job communicating what is going on.
If your grandfather’s delirium is not improving, it might be that he is just very sick from an illness. That said, it’s important to double check that the hospital team have evaluated for any extra problems that might be making him worse. I would also recommend asking the hospital doctors to clarify exactly why he got sick in the first place (presumably this is the initial illness that provoked his delirium), and also what is going on with his health now (it’s common for older adults to develop complications while in the hospital).
You cannot make a good decision about taking him out without a clearer understanding of what’s happening now with his health.
If you try to talk to the hospital doctors and it doesn’t go well, here are a few other options to consider:
– Review the caregiver guides at NextStepInCare.org. There are several related to hospitalizations, and they contain good practical information on communicating with doctors and avoiding an improper hospital discharge.
– Ask to speak to the hospital doctor’s supervisor. Politely but firmly express that you have questions and concerns that you feel still haven’t been answered. Submit requests in writing when possible, as this creates more a paper trail.
– Some families end up hiring a professional patient advocate. These are people with experience in communicating with healthcare professionals and in navigating health care crises.
– Contact your local Medicare Quality Improvement Organization to report a complaint
Good luck, I hope your grandfather gets better. It can take a long time to recover from a long hospitalization with delirium, but some older adults do.
My 81 year old mother has experienced delirium multiple times with various hospitalizations over the last nine years. Her most recent bout has been the most persistent and it has remained throughout a three and a half week stay and discharge. After a while you become used to telling every nurse, doctor and caregiver you meet that this “is not her baseline” and that it is delirium. I have hired patient advocates and even consulted a doctor who is a delirium expert this time. None of it seems to make a difference. If you have a prior history and are prone to getting it, it will come. If they had to invent a delirium incubator they could do no better than your average hospital for in-patients, with efficacy increasing accordingly with each step closer to ICU. Hospitals are chaotic, confusing, unstable environments with changing faces, rooms, test, sounds, lights, needles, tubes, patients, trauma, pain .. you get the picture. A hospital may save your life, but it will often kill you doing it.
Thanks for sharing your story. You are absolutely right, hospitals are often very difficult places for older adults and this can bring on delirium. ACE units do help; experts estimate that about 40% of delirium cases can be prevented.
I’m sorry nothing seems to be helping with your mother. If you’ve consulted a delirium expert and still no improvement, then all you can do is create the most restful supportive environment, give it time (as in months), and hope for the best. Good luck!
I would imagine that ACE units do help. It’s too bad there are only about 200 of them for the 4000 hospitals nation-wide. To quote one ACE unit director on why more don’t exist “we aren’t glitzy and we don’t make a lot of money like cardiac-cath labs ..” What a grand healthcare system we have.
What is an ACE unit?
“ACE” stands for “Acute Care for Elders.” An ACE unit is a hospital ward especially designed to help older adults avoid common hospital complications, including delirium.
ACE units are usually staffed by a team of specially trained clinicians. The team usually includes a geriatrician, nurses trained in geriatrics, a social worker, a pharmacist, and a physical therapist. Exactly how ACE units provide care can vary, but it’s usually in line with best practices of geriatric hospital care. For instance most ACE units make an effort to not wake up patients at night, help older adults get out of bed sooner, are very careful about medication side-effects, are more proactive about preventing and checking for delirium, are more intentional about planning a safe discharge and working with family caregivers, and so forth.
You can learn more here:
Acute Care For Elders Units Produced Shorter Hospital Stays At Lower Cost While Maintaining Patients’ Functional Status
If ACE Units Are So Great, Why Aren’t They Everywhere?
ACE units are one of several “models of care” that have been proven to improve health outcomes in older adults. Unfortunately, they are still not widely available, probably because it requires funding and effort to get one set up in a hospital.
I still encourage people to learn about ACE units and ask for them at their local hospital. In a major metro area, you may be able to choose a hospital with an ACE unit, if you are going to have a surgery or other non-emergent hospitalization.
Another bout of diverticulitis has my 73 y o husband in the hospital for second time in three months. He has Lewy Body Dementia, so the hospital delirium is just adding more difficulty. The staff is doing everything possible to keep him safe: low boy bed with special mattress, sleeve to protect IV site, bed alarm, safety rails, fall pads on both sides of bed; and he now has a sitter around the clock.A low dose of trazadone was added last night for the REM. It is devastating to watch him; but hopefully he will not remember any of this. A
Yikes, that is a tough situation but at least it sounds like the hospital staff are paying close attention. Sometimes it just not possible to avoid the hospital or to avoid delirium. I am sure he appreciates your presence when you are there, as virtually all older adults find it comforting to have familiar people close by. Good luck!
I hope you can give me some advice. My wife, only 42 yrs old, had a double bypass. Went 2 hours longer due to bleeding complications. Now, understand she already takes Morphine, ER and IR. She also is a medically stabalized Bipolar. After she awoke from anesthesia, she started delirium. We were there for the 5 days including day of surgery. All the Dr’s could tell me is that the delirium will go away once we get home and for me to just play along but don’t play into it.. We went home on day 5. She suffers from paranoia and some hullucinations and almost like a Schizo state. She believes everyone is out to get her. It has now been 11 days and she seems to have taken a few steps backwards and I don’t know what to do. Please help if you can.
If she still seems quite delirious or otherwise is having more psychiatric symptoms than usual, then you must notify her doctors and insist that they evalute her.
Her situation is a little trickier in that she had pre-existing mental illness. Still, usually the symptoms of delirium slowly get better with time, assuming the aggravating factors (e.g. anesthesia, pain) have resolved or are getting better. So if she’s not getting better, the doctors need to check on what might be causing ongoing delirium. Could she have developed a post-operative infection or electrolyte imbalance? Could it be a side-effect of a new medication?
Try calling her primary care doctor and asking for an urgent care appointment to evaluate for delirium. Another option would be to take her to the emergency room, where they will be able to run tests more quickly.
Good luck, I hope she gets better soon.
I have worked 15 years on a medical/psychiatry unit and have seen many cases of delirium that have many different causes. One thing I have noticed in many of these situations is a propensity for the delirious patient to obsessively tie knots into just about anything they can get their hands on. It might be a gown, it might be bed linens or it may be an incontinent product. I have seen it all. I was just wondering if this is something that others have also observed?
Hm, now that you mention it, I agree that people with delirium do often fidget with their hands. Interesting observation.
I am sitting in Blount Memorial Hospital in Maryville, TN as I write this in my father’s hospital room. Three days ago, he had surgery for spinal stenosis. On the first day following surgery, he was pretty coherent and in fairly good spirits. Day two – he started the morning agitated by the tv remote and eventually wanted his shoes on and insisted we “have to go now”. I realized delirium was setting in when he started talking about having to go to Atlanta instead of going home.
Day three – the hospital called this morning to say my father’s aggression and combativeness escalated to a point that he was moved to a new room. He has been receiving constant dosages of Ativan to “keep him calm”. All I am reading about Ativan says it can create the confusion the patients are experiencing.
Tonight his nurse asked if I could stay with him in the room tonight. I am happy to help my father and do this for him; he would do it for me if the tables were turned. However, I now see how frightening delirium can be especially in a patient who becomes increasingly combative.
I am praying he gets out of this state soon.
I’m sorry to hear you are in this situation, you must be so worried about your father.
It is really wonderful that you are able to stay with him. Prayer is a good idea, as anything that calms you might help calm your father. Hold his hand if you can, too.
As for lorazepam, I imagine it’s a bit frustrating to see they’ve been using it, after what you have read. It is a very reasonable choice if the clinical team suspects alcohol withdrawal or other sedative withdrawal. Otherwise, there’s not really much clinical research to support using lorazepam, and some research suggests it’s a risk factor for developing delirium. (See here.)
A 2009 review reported that “Multiple studies, however, suggest either shorter severity and duration, or prevention of delirium with the use of haloperidol, risperidone, gabapentin, or a mixture of sedatives in patients undergoing elective or emergent surgical procedures.” You can read the full article here:
Pharmacological Management of Delirium in Hospitalized Adults – A Systematic Evidence Review
Despite the research suggesting that low doses of anti-psychotics are probably a better choice than lorazepam, for most older adults with delirium, it remains very common for clinicians to use lorazepam. I could speculate as to why, but suffice to say that it’s extremely common for clinicians to provide medical care that is not in line with recommended best practices. So, what has happened to your father is not uncommon.
In terms of what you can do next: you can and should help provide supportive care, as best you can. You might also want to consider talking to your father’s doctors about the Ativan, and about how they plan to manage his delirium. You could potentially mention that you’ve read that drugs like Ativan may be riskier than low doses of antipsychotic (we have the research references here to back you up!), and you could ask to discuss options for minimizing the lorazepam, or perhaps switching to a different medication if chemical restraint remains necessary.
Good luck, I hope your father feels better soon!
Hello, My mother is 82 with a history of anxiety and mild dementia. 8 weeks ago she was admitted to the hospital with a respiratory infection and a UTI. She was in for a week, sent to a rehabilitation center, checked out of there into a board and care for a week, then back to the hospital with pneumonia. For 8 weeks she has been bounced around from one facility to the next. Her mental health has been changing slowly over these 8 weeks.
Yesterday she suddenly changed for the worse. She was delirious, babbling incoherently, had no idea at times where she was or who we (the family) were. Today she can barely open her eyes. She has had medication changes 6 or 7 times in 8 weeks. One of them included a drastic lowering of her Xanax (from 6mg a day to 1.5mg a day then again a week later to zero, then back to .75 mg a day). The doctor is saying this is just part of her steady decline and is “normal” for her age and condition and has ordered hospice care.
We are wondering if she in fact has hospital induced delirium and if taking her home might help her regain some of her lost mental and physical faculties. Any help would be greatly appreciated.
A sudden change and worsening of mental state, such as you describe, certainly sounds like delirium. I can’t say why her doctor is describing this as part of her “steady decline”; it’s reasonable for you to ask extra questions and ask for further evaluation.
Whether to describe it as “hospital-induced” probably doesn’t matter that much. What is more important is determining what might have provoked the change, and what can be done to help her feel and be better.
Your mother has gone through several difficult weeks of illness, which have left her physically and cognitively depleted. A few months of illness and bouncing around from hospital to rehab does sometimes provoke a nearly irreversible decline in some older adults.
However, some older people do get better, especially once they have gotten back to home, provided home is a stable and nurturing environment. Hospice services can even help, in that they often provide high-quality supportive services in the home…some older people even “graduate” from hospice after 6 months because they have improved.
In terms of your mother’s recent worsening in mental status, I would say it’s usually appropriate for the clinicians to conduct an evaluation to look for a new cause or delirium trigger, such as a new or worsened infection, or a reaction to a new medication. Just because your mother has been in a downward spiral and is perhaps eligible for hospice usually doesn’t mean such an investigation should be waved off. Many older adults in similar situations have medical goals of care in which we evaluate and treat that which can be “easily” evaluated and treated (i.e. evaluated with simple tests and treated with oral medications; definition of “easy” depends on the patient and family’s desires but usually shouldn’t be too burdensome to patient.)
Her history of Xanax use creates an additional twist in her story. Xanax is a benzodiazepine and is quite habit-forming. It also slows down thinking and affects balance. Although we do generally encourage older adults to taper off this type of medication, it sounds like her dose was reduced quite quickly. Often such fast tapers actually make people mentally worse in the short-term, because they have difficulty adjusting to the lower dose of tranquilizer. So this may have contributed to her getting mentally worse in the short term. (For more on how to safely reduce benzodiazepines, including a handout with a suggested tapering schedule, see How to Help Someone Stop Ativan.)
I hope this information helps. Good luck getting her home and more comfortable.
Thank you for this information, it has been incredibly helpful. My mom is 72 years old, and had a stroke in late January 2017. She was hospitalized and then discharged to rehabilitation in order to work out the residual effects to her life side. During the rehab, we noticed that her normal disposition (sweet, kind, docile) changed. She became aggressive and combative. She was prescribed 10 MG of Lexapro. It seemed to help. She was discharged to our home, and her personality returned to normal. In February 2017, thinking that she could walk with a cane, she fell and broke her hip. She needed emergency surgery. She was hospitalized for 3 weeks, during which her health declined tremendously. (Decreased appetite, energy, etc). She was unable to do rehabilitation in the hospital because of her declined state. Underlying all of these problems is the fact that she has lupus. She was discharged from the hospital to a nursing home in order to gain strength back. The nursing home is a disaster, and I’m being kind with that description. It’s old, depressing, and extremely uncomfortable. However, during this nursing home stay, she has become incredibly paranoid, thinking that the nurses are going to poison her, etc. Yesterday, she went on a hunger strike. While admitted, they have continued the Lexapro. We are working hard to get her released from the nursing home and provided with in-home care, but these things take time. We are doing what we can for her, in terms of keeping her grounded, calling and visiting. From your standpoint, and I’m thinking moreso for insurance purposes, etc, is it important for us to broach this topic with the doctors so that it’s part of her medical record? I highly doubt the facility that she’s in will do anything more with this information. Or, should I broach the topic with her PCP? Thank you ever so much.
Gosh, I am really sorry to hear that this has happened to your mother. It is unfortunately common for one serious health event to result in such a cascade of health problems.
I do think you need to bring up your concerns. I’m not sure how it will help for insurance purposes, but you should bring them up a) for the sake of your mom’s wellbeing, and b) if more families bring up concerns, that helps change institutions and systems.
From what you describe, it sounds like your mom experienced delirium during her first stint of rehab. Now she’s in rehab after hip surgery and she is very paranoid. This might be lingering delirium from the first time around, but if she is paranoid or confused, you should absolutely ask the facility doctors to evaluate her for causes of paranoia and confusion again. For instance, her paranoia could be related to any of the delirium triggers I mention on this website, including:
– a new infection, such as a new UTI
– poorly treated pain or constipation
– medication side-effects
– an electrolyte imbalance
– dehydration
When older people remain in the hospital or rehab for more than a few days, we often have to check for these triggers repeatedly. So you should ask her doctors about this. Also ask to see what medications she is on. Sedatives and anticholinergics can make older adults more confused.
Also, if you think the rehab facility is of poor quality, you should complain. You can write a letter to the leadership of the facility, outlining your concerns. There may also be an ombudsman you can contact. Use Google to find out how to file complaints in your area. There is info on Medicare.gov here:
Filing a complaint about your quality of care
I would also recommend you review the free family caregiver guides at NextStepinCare.org, they are excellent and there is a whole section devoted to supporting an older person who is in a rehab facility.
Short-Term Rehab Services in an Inpatient Setting
Also do broach the topic with her PCP. Some are willing/able to get on the phone and make changes for their patients; it partly depends on the doc and also depends on his/her relationship with the facility. Certainly cannot hurt to ask the PCP for help.
Lastly, now that hospitals are responsible for readmissions, you could try contacting the discharge team for the hospital. They might be able to intervene as well.
Good luck and keep insisting, as best you can. Your mother is very lucky to have you looking out for her.
Thank you. This information was very helpful!
Hello , Sorry If this offends anyone but I’m really distressed seeing my sister today .. My 42 year old sister is type 1 diabetic 29 years now , she has many many complications and has had a stroke in the past , her kidneys have failed leaving her on dialysis 5 days a week , she has lost her sight , and had her lower leg amputated last August , she was up and about 9 days after her op and although spend 17 weeks in hospital from infection after the op she was doing remarkably well … Unfortunately 3 weeks ago she was rushed to theartre for an emergency op to have her other leg amputated … through her knee , she was in HDU for just over a week , but is now on ward which I believe she shouldn’t be … my sister has been unresponsive for a week and a half and only came round last night, today whilst I went to see her she seems agitated distressed and as some other family left she asked me to come close so she could tell me something important. .. she told me the nurses were treating her badly that she needed to get out of there , that I had to get her home … Then other family came and she stopped , before I left I told her I would be back tomorrow and she could if she could remember the important things tell me again tomorrow, she said she would not ever forget what she wants to say to me … My mum , my sisters daughter and my daughter went to see her tonight they asked her why she was so distraught and wanted home she told them the nurses are being bad to her they are taking her from the ward at night to a room and jumping on her bed … that they allowed for her to be assaulted by a doctor , that they are hurting her … I have researched looking for answers to what it may be and I find post op delirium scream out at me … Although it mainly says it’s usually older people to suffer … It seems she has all these things which are describing pot op delerium. .. How can we get docs and nurses to take us seriously that this may be what is wrong … Some nurses have said she was being agressive and agitated also verbally abusive and this is not like her at all she’s been in and out of hospital 29 years and adores all these medical staff who care for her … please any advice appreciated
So sorry to hear that your family is facing this situation, it must be very difficult to see your sister like this.
Yes, what you are describing could very well be delirium. It is more common in older adults but can also happen to younger people, especially if they are very sick or otherwise under a lot of medical stress.
It is important in such situations to be polite but persistent in bringing up your concern to the doctors and nurses. You want to be sure they realize this is not your sister’s usual behavior or mental condition.
It would be reasonable to bring up your concerns and ask them some follow-up questions. For instance, you can say “I’m concerned that her mental state is really different from usual and that this might be delirium. Do you agree that she might be experiencing delirium? Or do you think it’s something else?”
If they agree it’s delirium, then you may want to ask additional questions about what they think is triggering it, what their plan is for checking for common triggers, and how they propose to manage her delirium. Yes it’s possible that it’s just due to residual effects of anesthesia and her surgery, but usually it’s also appropriate for doctors to check for other common triggers, such as:
– untreated pain or constipation
– urinary tract infection
– medication side-effects; sometimes delirium is made worse by medications that are given to “calm the patient down”
– other new infection or illness
Once the delirium triggers have been identified and treated if possible, then the person needs some time and support to get better. For many patients, visiting family members can provide reassurance and comfort.
Good luck, I hope she gets better soon.
It’s such a relief to have found this site and thank you to everyone for posting their experiences about a loved one going through Delirium.
My mother is 69 years old and was diagnosed with end stage kidney disease a year ago. She has had a few visits to the hospital over the past year with infections and water retention. She dealt with those visits fine. Besides a bit of lethargy of late she was ok up until 2 weeks ago when she fell sick with sepsis again. Her kidneys have now shut down completely and we’re fast tracking dialysis.
I have full faith that she will physically be ok with dialysis but she developed Delirium a week ago and she is completely confused. Like others have posted on this forum she’s almost unrecognisable.
She is sleeping a lot at the moment and having non stop vivid dreams. The problem is that she thinks what happened in her dreams actually happened in real life. The delirium seems to be now non stop.
It’s extremely scarey to see my mum in this state and while I understand that her delirium will dissipate as the causes are treated it’s still very confronting and worrying.
The theory is when we remove the toxins through dialysis, completely treat the sepsis with antibiotics and get her bloods balanced the delirium should settle.
I have two questions.
1. She has had delirium for a week now and it has been getting worse each day. Her dialysis will start tomorrow. Does the period of time one experiences delirium before treatment for the causes commences have an impact on recovery time?
2. Will delirium leave any scaring thoughts which may impair her mental state when she recovers?
I look forward to your response and thank you again for this forum. Without we’d all have almost no where inline to help deal with and better understand Delirium.
All the best to everyone’s loved one going through Delirium.
Danny
Sorry to hear of your mother’s illness, this must be a difficult time for you and your family.
Regarding your first question: I’m not sure any studies have been done to correlate length of time delirious with speed of recovery. This would be hard to study because it would be hard to systematically collect information on how long an older person has been delirious.
Regarding your second question: some people do take a long time to recover back to their previous mental abilities (as in, months). And some people never get back to where they were before. Whether this is due to “scarring” thoughts is hard to say. In general, we rely on properly functioning brains to help keep our fears and anxieties under control. So often if cognition weakens, people become more anxious. They can also sometimes develop paranoias and odd beliefs.
But ultimately, every person is different. I think it can be helpful to know what types of possibilities to expect, but there is only so much under your control, or the doctors’ control. Part of caring for an older person with serious illness is learning to cope with a fair amount of uncertainty about what might happen next, and how well he or she will recover from the latest health emergency.
Dialysis will probably help your mother’s condition clear. You may want to double-check on her medications too, because it’s not uncommon for delirious seniors to be put on something to calm down their agitation. (And these medications can last a long time in people with poor kidney function.)
You can help your mother recover by fostering a supportive and restorative environment, by making sure any pain or constipation are treated, by double-checking on meds, and by speaking up if she seems to get worse again. If all delirium triggers have been removed or corrected, then it’s basically a matter of time and patience and TLC (tender loving care) while her brain recovers…and hopefully she’ll soon be back to her usual self.
Good luck!
My husband had a lvad put in and spent 15 days after surgery on ventilator, sedated high fevers 101 to 106 with everything else hooked up to him. He came off ventilator on friday but didn’t know who I was ,can’t speak currently tied and gloved. He was an on suboxone prior to surgery and had apparently been using steroids. The recovery has been slow. I’m not sure what to expect. I think people.need to be more aware of this. Thank you for your time
Delirium in the context of the medical or surgical intensive-care unit (ICU) is indeed common. I think of it a bit differently, in that people are usually quite a lot sicker (or have had much more serious surgeries). They are more likely to develop medical complications during hospitalization, plus the intensive care unit also creates its own special set of stresses on patients, with more machinery and intervention. On the flip side, patients in the ICU usually are being watched and managed more carefully by the nurses and doctors.
In terms of what to expect: how quickly people recover from delirium varies from person-to-person, but seems partly related to how healthy their brain was before they got sick. Good luck with your husband’s recovery!
My 86 year old mom has been hospitalized 3x since the end of February this year and it’s been for dehydration and low sodium, but this last time she contracted the flu, and pneumonia at her 2nd visit, a bad uti and sepsis. All 3x she’s gotten delirium (she doesn’t have dementia). She’s been in 2 and a half weeks now, and her delirium isn’t subsiding.i was hoping to bring her home (and our house was just put under contract today to close June 9th), but the Dr is now thinking her delirium may be permanent? Do patients generally improve greatly at home? I will need help at home since someone needs to be with her 24 hours. Would my taking her outside for a walk in a wheelchair maybe help while she’s in the hospital still? They’ve checked again for any lingering infection or new ones, and there are none now. She did get dehydrated because she’s hardly eating or drinking, and a feeding tube was just put in through her nose this evening to run 7p-7a. I’m so worried about her and up until this, she’s been very healthy and walks with her dog about a mile daily, is very sharp, and lives with us. She does have stage 3 kidney disease from her BP meds. Other than photos, lights on, a blanket from homr, trying to be there as often as we can, is there something else I can do to help her overcome the delirium a bit more, so I can get her home to try and recover? Thank you do much for this information and your site. Truly helpful and easing my mind. Xo
So sorry that your mother has been sick recently. It sounds like she has really been through a lot. That said, if she was walking a mile/day and quite sharp before all this happened, I would expect her to have a decent chance of eventually recovering. I am not sure why the doctor would say that her current level of cognitive impairment might be permanent; that would be quite unusual, unless she has experienced some kind of stroke or significant injury to her brain during hospitalization.
Regarding how to help her improve: my experience has been that most older adults do improve once they get home, provided they have family or friends available to provide support and assistance as they recover. All but the best hospital environments feel at least a little toxic to older adults, and home is almost always better. But once home, it can take weeks — or sometimes longer — to fully recuperate from illness and delirium.
As for helping her while she’s in the hospital, all of your ideas are good. I would take her outside if she seems to enjoy it; check with the doctors first to make sure they don’t have any concerns about doing this. Also try encourage her to stay hydrated, and speak up if she seems to be having any pain or constipation. Good luck!
Here’s what Melissa H wrote to me recently; I am going to share as I hope this will provide some inspiration and encouragement to those struggling with delirium:
“I wrote to you about my mom in May ’17, & she had just been at Emory hospital for 1 month with pneumonia, the flu, a utility and sepsis. She developed delirium and was diagnosed with vascular dementia, after having been very healthy up until February. You are the only one who said, she could still have delirium and that you thought perhaps with her health being so strong before that she might recover- well, she DID!
It was a slow process and from April through July, she most often didn’t know who I was or where we were (we also moved mid June). By the end of July, I noticed improvements and then gradually she became more herself, but in October, she greatly improved and she’s about 95%back to her old self, if not completely herself. She can’t remember anything of the time she was mentally out of it, and truly, I’m thankful because it was a difficult experience. I can’t believe it! I was told pretty much that she would be how she was, which sadly was pretty crazy, but she is so sharp again and talking with everyone, social, just like herself. I wanted to tell you how much I appreciate you’re taking the time to respond to me and for your blog here. I can’t tell you how many times I read your response and it helped me remain hopeful that it was delirium she was experiencing. I tell friends whose parents have been diagnosed with delirium to give their parents time- it took my mom 4 months to really start knowing me again, and another 3 months to really get back to herself and remembering. I don’t understand it, but it seems nothing short of miraculous her recovery. She just turned 87 in September. Thank you so much for your generous help and information- for taking the time and the compassion you show. Xo”
Great news about you moms recovery. Gives much hope! Great news! Thank you for sharing!
Can I ask if Melissa’s mum stopped eating as my sister 55 was hospitalised nearly 2 weeks ago having gone through last 3 years breast cancer, fist failed reconstruction and lately second reconstruction prolonged wound healing up. They’ve said it’s delirium but think it’s stress related after many tests but no definitive results although the above gives me hope I’m concerned her not eating and now rocking and making noises is declining
hi Sharon: all we know about Melissa’s mother is what she wrote above, does sound like she wasn’t eating much at one point during hospitalization.
Sorry to hear about your sister. At age 55, she’s much younger, but younger people can get delirium if they are sick enough. I hope she starts feeling better soon. Good luck and take care.
So glad your mom recovered! Gives me hope!!! My dad had experienced hospital delirium earlier this year after lung surgery. It took about 3 months and he was back to his normal self. Well, 6 months after lung surgery he has had knee replacement surgery. We warned the drs this might happen and it did again. It has been 6 weeks since his surgery and he is still confused. He is doing great with the new knee but he just can’t get some things straightened out in his mind. He thinks that him and mom have another house somewhere, he calls mom his sisters name that just past away, etc… He will say that is mind is just messed up. He will carry on a normal conversation and then just something out of the blue pops out of his mouth. His sleeping has really been poor at night. Got some melatonin yesterday to see if this would help. Have you ever heard the theory that beta blockers (atenolol) could cause delirium??? My dad is 84 years old. Thanks!
Sorry to hear of your father’s difficulties. You were right to think he might become delirious again, because having prior delirium is a strong risk factor.
Atenolol and beta-blockers are not particularly known to cause delirium.
Trying melatonin to help him sleep is a reasonable idea. You can also try making sure he gets exposed to sunlight and fresh air during the day, as well as exercise. These things help reinforce a circadian rhythm. Also try to avoid TVs, screens, and alcohol at night, and try avoiding caffeine after lunch.
It can take months for delirium to fully resolve. Hopefully he’ll keep getting better with time. Good luck!
Thanks so much for getting back to me!! He is improving slowly!!
That’s wonderful!
My mother who is 73 has been in the hospital for four days now. She is sick with the flu, pneumonia, uti, and Mrsa. She has been confused every since she has been in the hospital. She is unable to walk, or to feed her self. It’s very scary seeing her in this condition. She was fine before this.. walking and talking. She is also a dialysis patient as well. I believe she is experiencing what you discribe in your article. She seems dazed, and confused. She sometimes does not know who I am. Is this something she can come back from?
Yes, this sounds like delirium and usually it does get better eventually. However, as noted in the article and comments, it can take weeks or even months for a person to fully recover, and some people never get quite back to the way they were before.
If she is currently in the hospital, then she needs for her illnesses to stabilize and she should also be protected from as many hospital stressors (e.g. being woken up at night, not having glasses or hearing aids, getting a little dehydrated, constipation) as possible. After that, it’s really a matter of time and rest, to recuperate. Some people recover quite quickly, others take longer. Good luck!
It amazing to discover this site. First of all, my heart goes out to the people with loved ones experiencing delirium. And I offer heartfelt thanks to you for providing education and support for this.
I’m 55 years old and have Parkinson’s disease. I underwent spinal fusion surgery 6 weeks ago, and ended up experiencing significant delirium. Thankfully it resolved pretty quickly when I got home after a week in hospital, but from the first-person perspective it had to be one of the scariest things I’ve ever experienced. I will definitely remember this when I help out with family and friends in hospital.
I do have one question: do different anesthesia drugs have different propensities to provoke delirium? Ketamine was used in my case.
Thank you!
Glad you find the site helpful.
Yes, some people who have experienced delirium do describe it as a very frightening experience. I’m glad you recovered quickly from your episode.
In terms of your question, I am not an anesthesia specialist, but when I briefly tried to look up your question , I didn’t find much on specific anesthesia drugs being more likely to cause post operative delirium. (Obviously general anesthesia is much more likely to cause delirium than spinal anesthesia or other forms of localized anesthesia.) Interestingly, one research study reported that ketamine helped to reduce the risk of post-operative delirium.
My guess is that individuals will have different reactions to different types of anesthesia. A sensible approach might be:
– Before surgery, let the anesthesiologist know you are especially interested in minimizing the risk of post-operative delirium. Ask if he/she can recommend any particular drugs to use or avoid for this purpose, and ask for other suggestions to acheive this goal.
– If you experience post-operative delirium, make a note of what anesthetics were used. A good way to do this may be to request a copy of the operative report. Then before future surgeries, make sure the anesthesiologists are aware of your past history, and how you reacted to the previously used anesthetics.
My 80 year old father has been recently diagnosed with heart failure. He was admitted to hospital since he was retaining water. The hospital got it under control with new medications and he was sent home after 2 weeks in the hospital. Everything was looking good. A week later he was back in the hospital with fluid in his lungs and stomach. He said he had stopped taking his new meds because he thought they weren’t doing anything anymore. He has been in the hospital for a week now and last night when I called his room they told me he had been relocated to a different room. I called the nursing station to find out what was the reasoning and was told that he has become very confused and was seeing hallucinations. The nurse also asked if there was any history of dementia in the family which his mother did have. I guess my question is: is the heart failure at the root of the problems? His first time in the hospital he was fine, joking with the nurses, enjoying the food… and now a week later it’s completely different. My other fear is that he lives by himself. Will he ever be able to live on his own again or is this something that he is going to need ongoing monitoring for? It’s really hard to see because he has always been so healthy and now it seems like his health is failing him. The hardest part of all of this is that I live about an 8 hour drive from him and am an only child.
Oh, that’s tough to be far away and an only child.
Hard to say exactly why he has become delirious during this hospitalization and not the previous one. There are a lot of things that can cause or contribute to delirium after a week in the hospital; if nothing else older adults are often worn out by being in a place where it’s hard to get some decent rest.
Sometimes they also develop complications such as urinary tract infections, and sometimes medication side-effects are an issue. (When I was an internal medicine resident, it was quite common to prescribe a sedative to hospitalized patients who were complaining they couldn’t sleep. Only later, during geriatrics training, did I realize we were putting those patients at risk of delirium! argh.)
Is the heart failure at the root of the problems? It certainly sounds like it’s at the root of why he was hospitalized these two times. Otherwise, delirium can come on any time an older person is physically stressed by illnesses and/or anything else that puts a strain on the body or mind. I would think of his heart failure as something that it will be important for your father to manage well, to prevent future exacerbations and hospitalizations.
Most older adults benefit from some extra help — from either family or professionals — after hospitalization, for at least a few days to a few weeks. Whether they need it long-term depends…some recover to full function quite quickly, some need more time and support, and some never quite get back to the way they were before. It is too soon to know what your father’s situation will be. But it would be really good if you were able to arrange some extra help from family and friends for when he gets out of the hospital. Some only children are able to get help from other family members who live closer to their parent, some recruit friends or people from their parent’s faith community. You can also hire professional geriatric care managers to assist, but that does cost money.
I would recommend that for now, you focus on doing what you can to help your father get through this hospitalization, and hopefully get some extra help and support for when he first goes home.
Once his situation has stabilized, it’s probably a good idea for you and he to do some advance planning for the future. (Try to wait until his mental state has had enough time to recover.) You or he can ask his doctors what kind of health declines or crises might happen over the next few years. Then you can talk about your options for managing them, should they come to pass. Usually there are lots of possibilities, but I will say that it can be tough for single older adults to get through health crises without having a relative or friend fairly close by who can help…so some older people do move closer to their adult children at this stage of life. I have more information on advance planning here, and don’t forget to address power of attorney for finances and general affairs, along with advance planning for health: Addressing Medical, Legal, & Financial Advance Care Planning.
Good luck, I hope his delirium and heart failure improve soon.
Hi there,
I’m from the UK and currently trawling the net to see if I can find any advice to help my elderly parents. My Dad developed Delirium from a fall and ended up hospitalised for two weeks. Sadly, the hospital staff did not recognise the signs – despite there being several poster about Delirium on the hospital walls! – and it went untreated until the family stepped upl
Happily my Dad recovered enough to be discharged and we recognised that it might take a few weeks or months for him to return to ‘normal’. This hasn’t quite happened yet but more worryingly he had a relapse last night returning to an agitated state where he felt under threat.
My question is how do you treat the symptoms of delirium in the home? My mum is 81 and not in the best of physical health herself and isn’t sure if she should quietly but firmly challenge my Dad? Or just go along with him till it passes?
Advice on this is a bit thin on the ground
Isabelle
A relapse would be concerning for a new or worsened trigger tipping him back into delirium. This could be a new infection, such as a urinary tract infection, or a medication side-effect, or any of a variety of problems that strain the body and/or mind.
So in the outpatient setting, if an older person develops new or worsened confusion, generally the best thing to do is to consider an urgent care visit to the doctor. Some doctor’s offices do have phone triage, in which case you can call, explain that your father’s mental state has just gotten worse over the past day, explain you’re concerned something could be wrong and provoking delirium, and ask how you can get him promptly assessed. Most doctor’s offices here in the US would have you come in for an urgent care visit or consider the emergency room, depending on what other worrisome symptoms you describe and what they know of the person’s medical history.
Challenging a person with delirium usually will only make them more anxious or agitated, so I don’t recommend that at all. It’s much better to be reassuring and try to soothe the person.
Waiting it out is risky, because he could be ill with a problem that requires medical attention.
So I would encourage your family to contact your usual medical providers and bring up your concerns, the sooner the better. Be sure to emphasize that this is a definite worsening in his usual state. Good luck!
Hi,
I was so happy to find your site today. I was looking up information regarding confusion in elderly hospital patients because I just got my mom out of the hospital a couple of days ago. The hospital stay was a nightmare for both of us. We had experienced the delirium before after her hip surgery and pretty much chalked that up to the anesthesia and pain meds (I had them change out the pain meds for something non narcotic). This time she went in for what was determined to be a slight case of pneumonia and after the first day, it hit the fan. So after reading your article I feel such relief that I can’t even tell you. She is home now and feeling better with residual anxiety from her stay. I told her I have printed the information off so she can read it for herself and hopefully will feel a little better about her mental health. Her doctor had actually ordered a CT Scan of her brain because of her behavior. I find it absolutely ridiculous that doctors are not more aware of this especially since my mother lives in an area with a majority of senior citizens. So thank you so much for this article and for everyone who contributed with their questions. It has really made a difference.
Thank you for this comment; I’m so glad you found this information helpful and reassuring.
Since you mentioned narcotic pain medications: The truth is that the relationship between pain medication and delirium is complicated. Narcotics can cause confusion, however a study of opioid use in hip fracture patients found that using these painkillers was not associated with delirium.
Research also suggests that under-treating pain can provoke delirium. So, usually a careful balancing act is required.
I hope your mother recovers from her recent hospitalization soon.
Can I have some information on my having a delirium experience for 3-4 days after surgery. I am 71 and remember that when I was in the delirium state I was food shopping, visited friends and was trying to call 911. To escape the hospital. I called my husband to help me with the groceries to the point where he really thought I was out of the hospital. I was in and out of reality.
How do I help myself now, knowing I have to go back in the hospital for back surgery and I don’t want to put my family through that again. What can I learn from listening to the blogs from other people and not be such a burden to them this time?
Thank you
M
Sorry to hear that you yourself have experienced delirium.
Experiencing delirium is unfortunately associated with a higher risk of developing it during a subsequent hospitalization or illness. So, I think it’s very good that you are taking steps to educate yourself and try to reduce your risk of delirium for this upcoming surgery.
To reduce your risk, start by reading more about what patients (and/or family members) can do to prevent delirium. The Hospital Elder Life Program (which was designed by a delirium prevention expert) has suggestions here: Healthy Living: At The Hospital. Their suggestions include making sure you have vision/hearing aids available if needed, staying hydrated, being careful about medications, and trying to get out of bed regularly.
Some additional things you can consider doing:
– Choose a hospital with an Acute Care for Elders Unit if possible
– Make sure your surgeon and doctors know you had delirium in the past. Tell them you would like their help in minimizing your chance of developing delirium again. Ask them to explain how their team works to reduce the risk of delirium. If they wave you off and say “there’s nothing to do, it just happens to some people,” consider having your surgery done elsewhere.
– Ask if it might be possible to do your surgery under local or spinal anesthesia.
– Try to have a family member or friend available to stay by your side while you are hospitalized. They can help make sure you get help for any pain, constipation, or other symptoms. They can also help implement the suggestions mentioned on the Hospital Elder Life website. See the “Ten Tips to Avoid Confusion in the Hospital” section here: What You Can Do (Hospital Elder Life Program)
Last but not least, consider whether your back surgery is absolutely necessary. It may be necessary to get a second opinion or otherwise research your particular health condition. Although many surgeries are worth the involved risks, in some cases people find that an alternative non-surgical treatment plan can offer similar benefits with fewer risks. Good luck!
I thought that the information given to me through the podcast was very informative and I feel very confident that if I had to go back into the hospital I would be more assertive in asking for help and I have much more information about delirium to prepare myself as much as I can with the information I now have and understand to know that I did all that I could to prepare for myself for whatever happens.
I have heard from the medical team that it might never happen again but I know that it also can happen again and that is what I will be ready for to hopefully lessen the problems of getting the delirium again. Education is the best protection for me. Thank you for everything.
I’m glad you found the podcast episode on delirium helpful. Good luck preparing for future hospitalizations. I wish every person who had previously had delirium would take steps to reduce their risk for the future, as you are doing.
My mom was in the hospital for 4 weeks being transfer to a rehab. facility. Mom became very confused and agitated and the nurses response was to keep giving her Ativan. Most of the nurses provided nursing task care but did not give nursing care there was minimal interaction with her even when they came in to do care. There were a couple of nurses who were wonderful, but I really question why these women and men went into this profession. I am resigning from my job to take care of my mom, . Communication is a hallmark of nursing and can prevent or minimize complications. I firmly believe if the nursing staff had just talked to her about anything, the weather the news anything a lot of the mental status changes might have been minimized.
Oh, that is sad. You are right, nursing has historically been quite a caring profession, and I think most people go into this career because they want to help.
But in many environments the nurses are given too much work to do in too little time, or are burned out, or sometimes the leadership at the top just isn’t providing the right direction and support. So many patients and families end feeling they aren’t getting quite the “care” they need and deserve.
Re the Ativan, presumably it was prescribed by a doctor…
I applaud you for mobilizing to take care of your mom, but don’t forget to take care of yourself too! Hope your mother feels better soon.
My 95 year old mother was admitted into the hospital for pneumonia after the first day she was there she became hostile with her whole family (She has seven children). Ever time we visit her she screams and yell that she was in a hole and that we hate her and want her to die. Nothing we said to her would convince her other wise. We tell her how much we love her but she is convinced we want her dead. It is very upsetting because we don”t know what to do and she doesn’t want us there, she wont”t eat, and refuses medicine. She has since gone back to the assisted living/nursing home that she has been at for 3 years but after two days is still acting like this. Before she want into the hospital she was mentally fine just a little forgetful. Is there anything we can do to help and will this pass soon. Should we continue to go see her even if she doesn’t want us there or should we let things settle down a bit. We are at our wits ends.
Gosh, this is a tough situation. Usually, people with delirium find the presence of family reassuring, but sounds like this is not the case for your mother.
Your family and the assisted living residence will have to do some trial and error to figure out what she finds soothing. For some people, it’s a familiar blanket (or familiar surroundings). For others, it’s music they like. Or maybe she will respond more favorably to some family members than others?
What’s important is to not get into arguments with the person. If insisting that you love her seems to aggravate her (which it might, if she’s insisting you hate her), then you need to say something else. Generally being told they are wrong infuriates people. Feeling like their statements are heard and valid helps them feel better. If you can’t validate a particular statement (e.g. her shouting that you hate her), then try to validate her emotions in another way, such as saying “Wow, you feel like people are against you. That must be hard.”
Overall, if your visits seem to agitate her, then it may be a good idea to minimize them for a bit.
It’s hard to say whether this is likely to pass soon or not. Usually the older people are, the longer it can take for them to fully recover from delirium. If she’s been adequately treated for delirium triggers, then hopefully she’ll improve at least somewhat over the next week. Good luck!
hi have just found your site and its good to know in a bad way that we are not alone my 88 yr old bother has the condition after a hip op ( that went fine) however we thought we hhad cracked it 2 days of the old mum and today bck to square one ,… is tht usual ?
No, if you are concerned about delirium, you are definitely not alone 🙂
Re your mother, are you saying that she had delirium after a hip operation, was better for two days, and now is confused again?
This is not uncommon; the question is what does it mean and what should be done. One possibility would be that she is experiencing a new or worsened delirium trigger, such as pain, constipation, medication side-effect, excess fatigue, electrolyte imbalance, infection, dehydration, etc.
Delirium symptoms do wax and wane during the day. But if someone seemed noticeably better for a few days and then gets worse again, it’s reasonable for the doctors to check for delirium triggers again. Good luck!
My mother is in the hospital for pneumonia and is being treated with antibiotics. From reading your article I see she may be experiencing delirium as she has been increasingly confused since her admission to the point where today she couldn’t remember her date of birth and is having difficulty with word finding. This is day 4 in the hospital and she is unable to feed herself, and after asking for her glasses, she kept trying to put them in her mouth. Does the loss of lifelong basic skills also fall under the category of delirium? I suspected a stroke, because the mental status changes are so dramatic. They did an MRI and said no sign of stroke. Should I ask for a neurologist consult and/or a psychiatrist consult? Looking forward to your answer.
If they did an MRI and say no sign of stroke, then it’s quite possible that the main impairment is that she is very delirious. Delirium does sometimes cause quite dramatic changes in mental abilities.
Rather than asking for a specific kind of consult, it might be better to tell the doctors that you are very concerned about possible delirium, and ask them for more information about what they’ve done to evaluate it, and how they are planning to help your mom recover. If you don’t get good answers or they seem unsure, then you can ask if a specialist is available. A neurologist may be better able to evaluate for other neurological abnormalities. Good luck!
Hi – I am at a loss !! Was hoping I may get some answers from you. It all started approx. 7 weeks ago. My Dad lives with us and we have been taking care of him for many years. He does have heart disease – but at 84 besides getting a little weaker with age – he was able to take care of himself with minimal help. However, 7 weeks ago we took him to the doctor for retaining water in feet & legs (something that does happen from time to time) we were told his bloodwork looked ok – to keep an eye on him and any changes go to the hospital. Well within a week I called an ambulance – he woke up a little confused and not himself. While in the hospital – I checked his medication with hospital staff and found out that in the ER (even though they were given numerous times to numerous nurses a list of Dad’s medications) they instead followed what was on their computer from 4 years prior ! Some of these medications he was no longer on (Remeron being one) and or changed. He was very out of it he continued to show signs of irritability, acting out, sleeplessness etc. He was moved to 3 different rooms in 7 days. He only wanted to sleep and was very drowsy. We kept telling staff this was out of my fathers usual self. They kept saying it could be “sundown syndrome”. What did we know?? He was moved from the hospital after 7 days to a rehab facility. Still in a state of confusion !! I personally don’t think he was ready to be out of the hospital. However, while in rehab – for 2 weeks he was on a roller coaster of being in and out of conscientious. We told the staff this is unusual behavior for my father. He was there for 4 weeks and released to our care again back at home. Little did we know what we were in for – he was delirious – not sleeping, hallucinating – it was very difficult – we took him for his follow up visit to his primary – I asked about the changes in his medication while in rehab – one being why he was no longer on Xarelto? They said he was still suppose to be on that medication (another mistake!). Anyway they took bloodwork and again within a day my Dad is back in the hospital in a very grim state ! He went from being a relatively happy person to a person in despair. He had to be sedated, he was having many complications !! They finally diagnosed him with delirium (something I suspected all along but was told otherwise) and now having continued tests done to come up with the underlying issue. He also has aspiration (something he never had before !! ) So please tell everyone you know – even if you ask questions, even if you are there to help your family member, follow your instincts !! follow that gut feeling !!! I am so frustrated ! Thank you for your time – any input you have will be greatly appreciated.
So sorry that you and your father are going through this. It’s infuriating when such medication mishaps happen. He has had a rough time these past several weeks, not surprising that he’d become delirious. Also common for people in his situation to become demoralized and tired after being ill for such a long time.
It sounds to me like you are doing all the right things. Even though things haven’t worked out ideally so far, I’m sure your attention and advocacy on his behalf have helped at least a little bit. You are probably tired too, but to the extent you can keep asking questions and double-checking things and advocating for him, keep doing so. Good luck!
OMG!!! I felt like I was reading my own story. We kept telling staff that this was not anywhere near his baseline, but because he has a diagnosis of dementia (mild) and the fact that he is 88, they kept telling us that it was the dementia. He was previously independent, continent, walking, and doing work around the house. Within 2 days of being in the hospital he was totally changed. Dementia doesn’t progress that quickly but nobody would listen. Then we also found out that they used an old medication list in spite of my mother giving them a list of his current medications. He ended up on 4 different medications, 2 of which he had a horrible reaction to the last time- became almost unresponsive. I don’t understand why if there was a discrepancy between what my mom said was his current list and what they had in the system, why the primary care physician was consulted. I feel that if they had done this there possible could have been an avoidance of the delirium. It took them a full week before somebody finally read his history and found out how he previously responded to those medications. It makes me want to scream. We are still in the throws of dealing with this and are hoping for a reasonable outcome, but aren’t really sure. Unsure if bringing him home to familiar setting is better, but then you risk never getting back into a nursing home if managing him at home becomes too much. It’s so sad how our health care system works.
Thanks for sharing your story but ugh! I too want to scream when I find out that health professionals have been ignoring the med list that the family brought in. Also infuriating when they don’t seem to hear a family telling them that the current level of confusion is much worse than the older person’s usual.
In terms of your particular situation: impossible for me to say what is best for him in particular, but in general, many people like him seem to recover better at home than at the nursing home. It’s usually the more reassuring and restorative environment. On the flip side, bringing an older person with delirium home can be a lot of work for the family.
I hope your father gets better soon.
My mother who is 86 is presently hospitalized with Delirium. She resides in a seniors lodge and suddenly became confused and started having hallucinations. While the Dr. was quick to recognize the problem, the nursing staff are another story entirely. From everything I’ve read, they do not understand Delirium at all. They seem to be under the impression that she is just old and confused. They have been tying her into a wheelchair, even though she is quit capable of walking, and keep all of the rails UP on her bed so that she cannot get out of it. This is quite upsetting to her and she is also extremely embarrassed that she has been forced to pee in her depends because of being trapped in her bed. I spoke with the LPN and the charge nurse yesterday, and they both had different excuse as to why she is being restrained. One said she was unsteady on her feet (she’s not) the other said she refuses to wear her shoes. To make matters worse the RN that was working 2 days ago, untied her and “set her free”. She said she was doing well and we found her in the open area quite happily doing a puzzle. Last night I go to visit, and she is tied to the wheelchair again. The nurses on shift told me that they didn’t know anything about her being unrestrained past two days. Told me there must be some miscommunication. I said I was here both days, I know what I saw. She only has minor confusion at the moment. Knows where she is and why, and she hasn’t taken a fall, nor has she tried to leave the building. At this point I am pretty certain that the nursing staff just don’t want to have to keep an eye on her. Although I am at work, I have a call in to her Dr. and am waiting to hear from him. The thing that really makes my blood boil is that I don`t believe they would try this on someone who wasn’t elderly.
That is really too bad, if the nursing staff aren’t providing your mom with the right support as she recovers from her delirium. If you have time, I would recommend sending the nursing supervisor a letter. Often concerns voiced in writing are taken more seriously. You may want to remind them that restraining older adults with delirium is now discouraged by experts. I hope your mom continues to improve. Good luck!
Hi,
I just came across your website and it has given me great hope that there is someone ‘out there’ who can help and who understands this frightening condition!!!
My Mum had cataract surgery last June however the lens in her eye slipped and she had to have corrective surgery last Wednesday which required a general anaesthetic. Two days after the surgery she developed post op delirium. She spent four days in hospital before we got a diagnosis and for most of that time she was extremely agitated, abusive and even violent. Needless to say all this behaviour was totally out of character and very frightening both for her and us her family.
She has been home for two days and we didn’t receive any guidance on her care before she was discharged so we feel very much in the dark at the moment. I did speak with her own private doctor who advised us to keep reassuring her etc. She has been fairly good over the last two days since discharge but this evening has seen her slipping back and while she says she knows she’s at home she feels as if there is something wrong and that we have ulterior motives for being nice to her!
I have been reading up on post op delirium but I still feel at a loss when it comes to providing care for her. I also feel angry that no one warned us about the risk of this delirium. My Mum is 81 and other than suffering from reflux from time to time she has good health. I am frightened that no matter how much we reassure her that it won’t be enough.
Perhaps you could help answer some questions for us?
Is it normal for the symptoms to get worse later in the day?
How can we or should we try to explain what is happening to her when she is lucid?
What should we do when reassurance just doesn’t work?
Normally my Mum and I have a great relationship but I’ve noticed during her delirium episodes I seem to be one she lashes out at most, is this common?
Any help or advice that you can give us is greatly appreciated because at the moment we feel very much at sea and no one has really given us anything concrete to work with.
By the way we are living in Dublin, Ireland.
Many thanks.
Ok, let’s see if we can help.
First and foremost, take a few deep breaths. Remember that your mother will probably sense your stress and anxiety, so it’s helpful if you can find ways to accept the craziness and the situation as best you can. Sometimes you will be doing everything right and she will still be paranoid, or lashing out, or confused, or otherwise not as you wish she’d be. At those times, tell yourself that you are doing what you can and in all likelihood, with time things will get better. Now you are also going to try to make things better for her, but you can’t try too hard or be too invested in what you do working right away.
In terms of your specific questions:
– Yes, people sometimes get worse later in the day. Probably this is because they are more tired and so it’s easier for the brain to go a bit haywire.
– I don’t think there’s an exact right answer re what to say when she is lucid. I think for many older adults, it’s anxiety-provoking to hear that they’ve been acting strange. So I would start by being low-key about it. Maybe only talk about it if she asks. But really, what is most important is to pay attention to how she’s responding. If she is asking you a lot of questions about what’s been going on, then you may find it’s best to tell her a bit and be reassuring. Probably I would err towards the side of saying “let’s talk about it in a few days when you’re feeling stronger. What’s most important now is for you to rest and feel relaxed.”
– When reassurance doesn’t work: First, make sure you aren’t arguing or trying to convince her of something. If she accuses you of something, don’t explain why it’s not true. Instead, validate the emotion and redirect. Second, make sure she’s not in pain or constipated or overly tired or experiencing some other stress or discomfort that might be triggering her. Otherwise, sometimes reassurance just doesn’t work. This is when you have to practice a little acceptance of an imperfect situation, try to not get too anxious yourself about it, and give it some time.
– Re lashing out at those you are closest to: it’s certainly not uncommon for older people to do this. It can be really tough for families to go through this. Consider getting support through an online support group; there’s a very active forum on AgingCare.com.
With time she will likely improve, but it can be hard to weather this period while they slowly recover from delirium. Good luck!
Hello, my father is in hospital suffering from severe gout attack. Lots of complications. He suffered from deliurm when he was on steriods but he came round to his normal self. He now has diabetes as the hospital was not checking blood sugar levels while on steriods and nearly went into a diabetes coma. He is now delirious again but not on steriods. The doctor has told us it’s probably because of high inflammation in the bod but we are very worried. This behaviour is not normal but hospital does not seems to take us seriously. He is 80 and a history of alcohol addiction. Is there anyway we, the family can help? Thanks
Well, with the delirium in the hospital, the first challenge is to make sure the hospital staff are aware that the older person is not being his usual self. It sounds like this is the case for your father, and that his doctor does realize he is delirious.
In this case, the next step is to try to make sure that he’s been thoroughly evaluated for triggers and contributors to delirium. If he is having a bad gout attack, that in itself could provoke delirium in an older person. But you can still ask and make sure that he’s not getting medications that might make him worse, or is constipated, or is getting woken up all the time at night, or is in too much pain, and so forth. You can also ask if all his electrolytes are in normal range.
A history of alcohol addiction usually means an older person’s brain will be more vulnerable and prone to delirium, because chronic alcohol abuse damages the brain over time. However, if you think he was recently drinking, then it’s possible that he might also be experiencing some alcohol withdrawal right now. So be sure to bring up his alcohol use history to his doctors, if you haven’t already done so.
Once all the delirium triggers have been identified and treated as much as possible, then as family you need to provide a reassuring presence and just give him time to recover.
It is not an easy situation to be in. I hope he gets better soon, good luck!
My 65 year old husband developed sepsis from an serious foot infection (he is diabetic) Prior to this, he was getting forgetful but still did day to day activities. The infection resulted in surgery and a fixator was put on his foot/leg in order to save the limb. He developed Hospital psychosis and was hospitalized for a month. He was then discharged to rehab- that lasted about 3 weeks when he was kicked out as he kept trying to walk on the non-weight bearing foot and they did not want to assist him with bathroom, etc. He returned home unable to dress himself, wash himself, use the toilet. (none of if this was an issue before) After 2 days at home, he wound up back at the hospital since he had damaged the fixator. Surgery again and he has been in the hospital for 2 weeks. They want to discharge him and were going to send him to a new facility however the therapist at the hospital has now said that due to his ‘dementia’ he is not a good candidate for rehab because he doesn’t listen. Since his hospitalization this go round- he has not been “there” He is either delivering babies, riding a train or hanging out on the corner with a friend (his sitter) Mentally, he has checked out of the hospital and I don’t know what to do to get them to understand that this person is not the person I shared my life with less than 2 months ago? He needs rehab and nursing care for awhile to protect the foot until the fixator comes off. What can I do?
This is a difficult situation. There are a couple of options that you can look into, but they will likely all involve some work on your part or your family’s part.
It’s unfortunate that the therapist is labeling your husband as someone with “dementia,” because what you are describing sounds like he developed delirium and hasn’t yet had a chance to recover to his usual mental faculties. That said, he sounds quite cognitively impaired at this time. This means he’ll have difficulty participating in rehab activities, and also he’s likely to keep walking on his fixator and perhaps reinjuring himself.
Someone like him initially needs a lot of supervision and gentle redirecting. Hospitals will sometimes provide a “sitter” but I’m not sure how available those are in rehab facilities. Such supervision is tough for facilities to provide, because this requires staff time and also ideally staff who are trained to help people recovering from delirium (or people with dementia; the needs have a lot of overlap).
So your options. You can try insisting that he be discharged to the short-term nursing facility, and then you can try insisting that they provide him with adequate supervision and assistance. You will probably have to be persistent, ask to speak to supervisors, potentially write letters, etc. It might help if you or another family member can be present with your husband as often as possible, at least during the first week. This might help your husband recover from his delirium more quickly, and you can also be reminding him to not walk on the bad foot. You can also try contacting your local Medicare quality improvement organization; they are supposed to help beneficiaries get the right care. (Find yours here: http://qioprogram.org/contact.)
Another option would be for him to come home, and get his rehab through home health services. Again, he will need a lot of help and supervision, at least at first. This means a lot of work for you and your family. (You might be able to hire someone to help, too.) I do think that some people recover more quickly from delirium when they are home, because it’s a more familiar and restorative environment. But it can be a lot of work for family caregivers.
There may be some other possibilities, but those are the main ones that I can think of. Some people do hire a local patient advocate or a geriatric care manager. Such a person should be familiar with facilities and service providers in your area, which is an advantage.
Last but not least, if he is still acting delirious, then you may want to make sure that he has been recently checked for triggers and contributors to persisting delirium…people do develop new or worse problems, and these can keep delirium from resolving. Keep reminding all his health providers that THIS IS NOT NORMAL FOR HIM, and that you need them to help him recover from his delirium.
In short: no easy answers. He needs a lot of help right now, so you will either have to fight for him to get it, or provide some of it yourself, or work on both fronts.
I am truly sorry that our healthcare system tends to be so ill-prepared to help people like your husband. Good luck getting through the next few weeks.
My mother had an abscessed leak from diverticulitis and has been in the hospital for 15 days now but started with talking in her sleep on the 3 day now in a regular room she is now seeing things that are not there while awake and the CT scan shows nothing but to humor me he is going to do an MRI her hemoglobins are 7.2 and they want to discharge her and says ther is nothing wrong! I beg to differ!
Thank you Roseann H
Well, it sounds like she is still delirious. The main question is, does she have something going on medically that is keeping her delirious? Is her infection properly controlled? Could she be having pain or constipation?
Searching for these common delirium exacerbators is generally more useful than scanning the brain. (Unless someone has new neurological findings, we would not usually scan the brain because they had developed delirium.) Especially if she has already had an unremarkable CT, an MRI is unlikely to show anything other than possible cerebral small vessel disease, which really mainly tells you that she’s likely to be more vulnerable to delirium.
(You can learn more about this condition here: Cerebral Small Vessel Disease: What to Know & What to Do.)
If a good evaluation for delirium triggers doesn’t find anything, and if she is reasonably “medically stable,” then it may be reasonable to consider discharge. Many older people get better once they are home — it’s a less stressful environment than the hospital is — but they may need a lot of supervision and assistance during the first several days.
Her hemoglobin of 7.2 sounds a little low…be sure to ask what is the plan for checking on it and making sure that it doesn’t get worse. It’s also possible that her Anemia in the Older Adult: 10 Common Causes & What to Ask might be contributing to her delirium, but there are no studies of whether transfusing people like her helps delirium resolve or not.
This can certainly be a difficult and frustrating time for caregivers. You are right that something is wrong! What is tricky is determining what’s likely to help, and prolonged hospitalization may not be it. Good luck!
My mother had surgery several days ago and is suffering from paranoid and delusional behaviors. Unfortunately she attempted to pull out her IV which has lead to restraints. Her surgery was for a bowel obstruction however she is in renal failure and is refusing her dialysis treatment. She believes that the hospital staff is intentionally trying to hurt and believes that I am allowing them to do so. They are telling us that they can force her to have her dialysis treatment because it is not safe if she were to pull on the port and inhuman to restrain someone during the process. She believes that the are not really taking her to dialysis but an experimental room. Before her surgery she has considered stopping dialysis, which would be a choice she is entitled to however she can not make that decision in her current mental state. I am at a loss of what steps we should be taking and what I should expecting from the hospital staff. They don’t seem to know what is causing it and I’m not sure what they should be doing to help address it. We do not have the time to wait for it to improve since she can not go without her dialysis treatment for long. Do you have any advice on what I should be asking if the hospital staff?
Hm, this does sound like a difficult situation. Delirium is not uncommon after surgery, it could just be due to that but it may also be exacerbated by pain, constipation, electrolyte imbalance, new infection in urine or elsewhere, and so forth. So they need to keep checking for triggers or exacerbators that could be addressed. Otherwise, your mother needs time and rest for the delirium to resolve.
Now about her paranoia and refusal to get dialysis. From what you are describing, it sounds like she does not currently have the mental capacity to make that decision. (You are correct, she can at some point decide to stop dialysis but she needs to have decision-making capacity to do so.) She is going to need her dialysis, in part to help her delirium resolve. So if she is too agitated for them to dialyze her safely, then they may need to consider sedating her with medication. We don’t like to do this in geriatrics, but in this case the benefits likely outweigh the downsides. We would normally use an antipsychotic, not a benzodiazepine.
In terms of what to ask the hospital staff: Consider asking them to clarify their plan for ensuring that she gets the dialysis that she needs medically. Also ask them how her labs are looking, in terms of how urgently she needs dialysis. And ask if her lack of dialysis could be contributing to her delirium.
If her refusal to get dialysis is the issue, consider requesting an ethics consult.
Good luck, I hope she gets better soon!
We found out the hard way that we needed to dig in our heels about elderly family members being discharged too soon after being on opiods. I could tell that there was already something wrong, because he seemed agitated. Of course he wanted to get out of the hospital as soon as possible. The doctor discharged him, though we wanted him to stay at least one night until the medicines were out of his system. The doctor considered him competent enough to decide whether he should be discharged. Big mistake. They sent him home and, even though he seemed normal, later that night he unlocked the door and went wandering in the neighborhood and fell, so he ended up right back in the ER. He was having hallucinations and thought that it was seven in the morning – not twelve at night. It took about three days and nights for him to get back to normal in his actions and thinking. I also remember my mom thinking that she was staying in a motel, while in the hospital, and trying to wash the dishes in the sink!
Thanks for sharing and yikes, what a story. I hope your older relative wasn’t too badly hurt by this fall.
You are right, it’s important to ask questions and speak up if you think the clinicians may be trying to discharge someone too soon. Another option is to arrange for the older person to have some extra support and supervision at home, during those first few days and nights after discharge. Many older adults do recover from their delirium faster once they are home, because it’s a less stressful environment than the hospital is. However, this can be a lot of work for family caregivers and may not be a good idea if the older person appears to still be sick.
I was in the hospital after a couple of days, and suddenly I realized I didn’t know where I was. So I called my daughter from my cell phone and scared her half to death by saying I had no idea where I was; she had to come pick me up immediately . I didn’t see any people, although I’m sure they were there. My daughter came and reassured me and I came out of it.
The second time was in a rehab about a week later, when I had a lengthier experience. I dreamed that all the nurses were keeping me in a wheelbarrow/wheelchair type of thing and that they were all going to kill me. I tried to make sense of it all, and wondered why ALL the nurses were in on the plan. I think I called a few people b…., which was not usually in my vocabulary. When my daughter came, I told her about it, and then asked if she could see all the gold and silver threads that were all over the air; and I pointed to the ceiling on which I thought there was a map of Summit, NJ. No nurses or anyone seemed to notice my discomfort. Even though I knew about hospital paranoia at the time, it still bothers me when I think about it.
Yikes, that sounds pretty distressing. I’m sorry that the nurses and other staff didn’t seem to notice.
Having past delirium does put one at risk for future episodes, but older adults can reduce their risk by taking precautions — if possible — if they have to be hospitalized or get surgery.
Hope you have made a good recovery from this experience. Take care and good luck for the future.
It’s good to hear this first hand experience!
Thank you for this information! I am 60 and in the past ten months I’ve had three surgeries for rectal cancer, which included first, a colostomy, then an ileostomy at the time of the resection. I certainly wish I had known about post-op delirium before now! I experienced paranoia, confusion, hallucinations and tearful meltdowns, all of which occurred either coming out of anesthesia or at night, and after reading your article I can see it was caused by multiple triggers. It’s interesting to me how real the hallucinations seem even after a year. It’s also disconcerting that as sweet as my nurses were, only one seemed to be tuned in to my distress. Being very observant and kind, she used my faith and the importance of family to “talk me in off the ledge” one night. It seems to me it wouldn’t take a great deal of training to bring nurses up to speed on how to recognize and handle patients with delirium.
What a relief it is to have learned, on this one year anniversary date of that first surgery, that I wasn’t responsible for my strange behavior! I continue to have some loss of memory, and very often vocabulary as well, but I’m exercising on a regular basis now, both physically and mentally, which I believe is making a significant difference. Today I think it becomes my mission to educate my family and friends on this subject! With such a large, elderly population of Baby Boomers, I’m surprised this isn’t a more common topic.
Thanks for sharing your story. I’m glad you’ve found it so helpful to learn more about delirium. I agree, I wish more people understood this condition. Wonderful that you are helping others learn about it!
My 88 year old father was recently hospitalized following a fall at home. He has a history of CVA with expressive aphasia. He also has a dx. of mild dementia. Prior to going to the hospital he was independent with his ADL’s, continent, a community ambulatory (although walking on uneven surfaces was more of a challenge) and even did work around the house i.e. raking leaves, mowing lawn. Once admitted to the hospital he was put on medications that he was no longer taking even though my mother gave them a current list of his medications. Nobody bothered to clarify with his primary care physician.. He does take Kepra 750 for history of seizures but they ended up also putting him on Vimpat 200 as well as tegratol. Additionally they changed his HTN medication and added Amlidopine. He previously had a reaction to the Vimpat and Tegratol rendering him essentially unresponsive. Once they were eliminated, he gradually came back to his baseline. With this hospitalization he was on those seizure medications for a week. Then someone finally read through his chart and found out his previous reaction so it was then discharged. By that time he was barely aware, mixed up with sleeping ( up at night, almost unresponsive during the day), incontinent and barely able to walk. He was then transferred to sub-acute rehab. I kept saying that his current situation represented a rapid and drastic change, but nobody listened. I kept getting the response, “well the doctor really thinks it’s the dementia. Even advanced dementia residents are alert. Things were then pretty erratic. Some days, or portions of the day, he was better, then he would go back to eyes closed, barely participating in life. After I found out about the change in HTN medications, I requested that he go back to what he was on at home. That did appear to help somewhat. Also, previous to that I had them take him off his Namenda and Zoloft, thinking that they were causing him to be so drowsy and not consistently sleeping through the night. With each change in medication, I gave it about a week before asking for another change thinking that it might help pinpoint where the problem was. During this time I tried to get him out for at least a ride in the car. We then started to bring him home for several hours during the weekends. He would start out not so great, but by 5PM he was already perking up and moving better. We would then return him to the SNF as required by Medicare. The next day we were back to square one: not sleeping well, so fatigued during the day the he was barely able to participate in therapy, even though he was up all day minus an ~ hour nap. Because of his fluctuating participation he is not progressing well with therapy and will likely be cut by Medicare. I’m not sure if bringing home permanently would be better or not. Are the visits home more detrimental? My mother and/or I are with hime about 10-12 hours a day. If we bring him home and he doesn’t recover it’s going to be difficult to get him back into an SNF. It’s just me and my 84 year mother (who is in great shape for her age)
Ugh, so sorry you have had to go through this.
I do find that many older adults seem to do better at home, compared to the SNF. Home is usually a more reassuring and restorative environment, and that helps delirium resolve. He should be eligible for home health services, which can provide nursing and PT and OT and other services. But of course, he will need a lot of help and assistance from you and your mom if he comes home now, which may or may not be feasible for you to provide.
In terms of whether he can be cut by Medicare for not improving: the 2013 “Jimmo Settlement” established that improvement is NOT necessary, and that Medicare beneficiaries are eligible for rehab if it helps them maintain their current abilities. (See here.)
Your dad did have a pretty good level of function before he was hospitalized, so he may have a good chance of recovery. But it may well take a long time. Another reader shared the story of her mom’s delirium recovery with me recently, see here.
Your dad is lucky to have you there doing all this work advocating on his behalf! I hope he gets better soon. Good luck deciding on your next steps.
My 77 yro mom tas hospitalized last Sunday due to a UTI which caused an almost 104° fever. She was only blabbing and saying nonsense things. She was in the hospital for 5 days and 2 of them woke up sort of scared not recognizing where she was and thinking she was moved to another room. She actually doesn’t remember getting sick and being in an ambulance fue to the sky high fever. Doctors agree she was having delirium. She got some brain scans taken and the doctors said everything looked as it it supposed to look at her age. Seeing her like that frightened me quite a bit. She is back at her house now but I sense her somewhat slower than before this nightmare. I think I might be overwhelming her with questions and statements to make sure she’s OK because she gets very nervous when I start asking 🙁
Yikes, that sounds like a scary experience for your mom and your family.
It sounds like she is better now, although perhaps not quite back to her usual self. She may well continue to improve with time; many older adults do.
I understand your concern for her; I would want to be asking a lot of questions too. That said, if it makes her nervous, consider dialing back your questions. The more restorative you can make her environment, the faster she can heal. So you want to minimize anxiety and stress, or at least only make her anxious if there’s a really good reason to do so. Good luck and I hope she continues to improve.
Hello and thank you so much for posting this article, it’s so important and not enough people are educated on this. Our Dad just turned 83 and he’s been through so many things, I can’t begin to list them here. But in September, 2017 they tried to save his leg by doing multiple procedures and they couldn’t do anything more for him and had to amputate it. This was due to Peripheral arterial disease. It was our worst nightmare for him and it has been very stressful and upsetting to him. As he has been in the hospital and rehab (he winds up back in the hospital for one reason or another every couple of weeks), he has developed this delirium and it seems to becoming more severe. A lot of the Rehab and Hospital staff seem uneducated about it, and this doesn’t help. He is completely normal when he is home and the delirium didn’t start until a few weeks in, but it just keeps spiraling. I do have some questions.
Is there any difference between this and what they call Sun Downing?
He has had mild experiences with this during past hospital stays but has bounced back quickly when he returns home. This time around, it has been such a long time that he hasn’t been home and it has become so severe. He is not only confused now, but he is hallucinating and becoming belligerent to everyone around him. This is totally out of character for him and it’s so upsetting. What are the chances of him bouncing back when we finally get him home?
What can we do at this point to try and reverse it?
It’s all very scary, frustrating, and sad and we don’t know what to do. The hospital just called my Sister as we speak because my Dad is screaming our names at the top of his lungs and it’s 10:45pm. They asked her if they can give him morphine to calm him down and make him sleep. The staff at the rehab and hospital don’t seem to know how to handle it either. 🙁
Any words of advice that you can give would be greatly appreciated.
Sorry to hear that your father is in this difficult situation. Yes, what you’re describing does sound like delirium.
Sundowning is when a person with a dementia such as Alzheimer’s disease gets more agitated, or shows an increase in difficult behaviors, in the late afternoon or evening. It is probably somewhat related to getting tired. Sundowning has not been as clearly defined or studied as delirium.
In terms of helping your father: at this point he has been going between hospital and rehab for 2-3 months. So it is hard to know whether his current spells of shouting and agitation are due to delirium that hasn’t had a chance to resolve, versus a new cause or trigger (such as a new infection or complication). If a patient gets worse, it’s often reasonable to re-do an evaluation for common delirium causes: infection, dehydration, electrolyte disturbances, medication side-effects, and so forth. I also always recommend checking for constipation and pain.
A little morphine might be reasonable to try, if they have checked for other triggers and if they think the main cause is pain. Bear in mind that IV morphine only works for 1-2 hours and oral morphine works for about 4 hours. Morphine and other opiates are also constipating.
Home is often a more restorative environment where people can finally start to recover from delirium. You have probably already looked into this, but you might see if there is any way to bring him home with home health services. (This might require a lot of hands-on help from family initially, which can be tough to manage if everyone works.)
Good luck and I hope he starts to recover soon.
I’m writing this sitting in the hospital with my 79 year old mother. We brought her in two nights ago as she was having episodes of slurred speach which I feared were signs of a stroke. All tests have revealed no stroke occurred. She has had very limited mobility over the last 90+days due to 2 pinched nerves in her back. Diagnosis was extremely slow and finally surgery was scheduled for December 27th. In the 5 weeks since the surgery was scheduled she has been in intense pain and has been on numerous meds to ease her suffering. Tonight she called asking me to call the cops as she feared the nurses would kill her. I’m great full to have found this article and the comments. I’m planning on taking her home one way or the other today to familiar settings to help her reorient as I’m afraid in this current state surgery would be delayed. I do not believe she can tolerate much more if the nerve pain is not fixed. I did not properly understand how this long term pain she has been under was affecting her. Would this cause the doctors to postpone or cancel her surgery? She has never experienced any dementia before and has been in great health. As others have mentioned this dillirium has been very unsettling. Seeing a loved one change so dramatically is devastating.
Thank you for your help.
Sorry to hear of your mother’s situation, it sounds very scary for her and for you.
If she has started worrying that the nurses are going to kill her, then it does sound like she may be developing some delirium.
Her pain sounds challenging. I can’t say whether the proposed surgery is likely to help; it really depends on her situation and what kind of surgery they have in mind. Obviously going through surgery is a strain on an older person’s body, so it would be best to proceed if the likely benefits outweigh the strain of surgery and the risk of complications.
I also can’t say whether they will want to cancel her surgery or not.
You may want to try to get a second opinion regarding the management of her pain, there may be some other possibilities to make it more bearable.
Otherwise, she might get better at home. Fundamentally, what she needs is for the underlying cause of her delirium to be treated and then for contributing factors to be minimized. If she goes home but remains in severe pain, this might keep her delirium from resolving as quickly as it otherwise would. Good luck and I hope she feels better soon.
Hi
My Mum was as diagnosed with delirium at the end of September. I won’t go into too much detail but we think it was related to a UTI (and possible diarrhoea, constipation and dehydration). My Dad and I tried to look after her at home but she ended up being admitted to psychiatric hospital at the beginning of November. Since being in there they had her on haloperidol (for 2 weeks), then quetiapine (another 2 weeks) then risperidone. On a night they’ve prescribed her zopiclone 7.5mg (after various other sleep related tablets) and mirtazepine. She takes 0.5mg risperidone on a morning and 1mg at teatime. Some nights she gets some sleep others she doesn’t. She is at her worst on a night and is confused. Although does come out of the confusion once she’s been awake awhile. She is agitated although does have settled periods. She is very drowsy during the day, even with sleep. She also has a morphine patch for pain. The ward have now said she has vascular dementia (along with the delirium) as they did ACE test and a CT scan (small infarcts from TIAs). I am really concerned about the medication she is on. Oh, they’ve also just started her on memantine (I know, VD, not Alzheimer’s) at teatime. My Mum came home on Monday on leave and will then be discharged. I want to look at reducing her medication. The ward seem reluctant. My first thought was the risperidone (due to
the dementia diagnosis and that she’ll be dropping off an hour or two after having it) from 1mg to 0.5mg at teatime. She’s fairly settled at this point and even when she’s had it at 7.30pm she’s been fine. She’s in bed by 9.30 anyway (will fall asleep no problem but wakes after a couple of hours). I wondered if anyone had any advice or thoughts? And on the fact that she’s been diagnosed with dementia (scoring 46 on ACE test) when she still has delirium. Prior to the delirium she was doing online banking, planning activities, looking after grandchildren, baking etc etc.
Thank you.
Sorry to hear of your situation, sounds very tough and scary for your family, and probably for your mother as well.
She’s now been confused for several months, but if she really was doing banking and otherwise doing quite well prior to September, then I’d say there’s a chance that with enough time and rest, she might improve…probably not back to the level she was before, but perhaps better than she is now. People may need to be home in a familiar environment for months, in order for delirium to fully resolve. The challenge is helping her get enough rest and restoration without over-medicating her, and this can be especially hard if her confusion is causing a lot of difficult behaviors.
If she is often drowsy during the day, then it certainly might be possible to reduce her medications. You will need to work closely with her doctor to do this. Here are some articles on the site that might be helpful to you:
5 Types of Medication Used to Treat Difficult Dementia Behaviors
4 Medications to Treat Alzheimer’s & Other Dementias: How They Work & FAQs
How to Manage Sleep Problems in Dementia
Cerebral Small Vessel Disease: What to Know & What to Do (This might help you better understand her head CT findings.)
Also if she is coming home and is often confused, I highly recommend getting more education and support on managing difficult dementia behaviors. There is a good overview here: Caregiver’s Guide to Understanding Dementia Behaviors. You can also learn a lot from an online (or in-person) support group.
Your goal should be to minimize conflict with her and upsetting her, so that any remaining delirium can resolve over time. So for instance, make an effort to avoid arguing with her or trying to reason with her, and instead offer lots of love, support, and whatever generates more positive emotions and fewer upsetting ones.
All of this is hard to do, when one is tired and stressed out and misses the way our older relative used to be. So be sure to take care of yourself when you can, and keep reaching out for information and support. Good luck!
Very interesting article – My 94 yr old Mum went into hospital with heart failure she has had for a number of years – within 3 days she was confused and frightened and wouldnt eat or talk – she also seemed to lose all of her reasoning power – the doctors seemed to have written her off and even mentioned to me (in front of my mother!) that she ready to die !! – I said she needs to come home as she will improve – so against their judgement I organised a package of care 4 times a day – and withing 2 days she was eating , drinking and sat up in bed talking to me !! I did however mention Hospital Delerium and they looked at me as though I was mad – so I told them to Google it !
However now she is eating me out of house and home as she has a voracious appetite but unfortunately become doubly incontinent – I know she is unwell but ready for the scrap heap I dont think so – Thanks again for an amazing article
Hm, what you describe does sound very classic for delirium and I can’t imagine the doctors would be surprised by this. Perhaps what surprised them is that you knew the name of this condition.
Or perhaps they didn’t realize that her state in the hospital was not her usual state. Unfortunately, it’s not uncommon for clinicians to assume that a 94 year old person might usually be confused. And how awful for them to tell you she’s ready to die, and in front of her! I’m so sorry you had this experience.
A good appetite is often reassuring, but a lot of incontinence can be a lot of work to deal with. If it’s new or worse than usual, I would mention it to her doctors, as it might be related to a medical issue that can be treated or improved.
I’m glad she’s better and thanks for sharing your story.
All these stories give me so much hope.
My mother has just been moved to temporary respite care after 4 weeks in hospital with severe hyperactive delirium. Though in the last week she became stable but very drowsy. She also refused food on the last day.
In respite the food refusal and also liquid continued for the first 2 days. She also had some confusion and hallucinations.I waited 2 days for a doctor to come and see us after I raised my concerns on day 1.
My mum is 84 and was totally independent before her knee operation. I even had her walking at least an hour a day whilst in hospital. After 5 minutes with my mother, I was totally horrified when the doctor offered “sometimes elderly people have had enough of life and refuse to eat and we should let nature take it’s course”.
I made it clear to the doctor that I would continue to advocate for my mum and expect her to make a good recovery. Hopefully she will recover.
Thanks
Sorry to hear about your mom. I’m glad this page has been helpful. Your mom is very lucky to have you advocating for her! If she was doing well before the operation, this gives her a better chance of eventually recovering. Good luck!
My Mum has emphysema and had a long episode of delerium last year (about 2 months long). During, she told my Dad that she had another child out of wedlock before she married my Dad. Dad said she had stretch marks on her abdominal area when they were first married.
Is it common for people who are experiencing delerium to create ideas like this in their minds? It would have been the early 1950’s when many young unmarried women were forced to give their babies.
Having a secret half brother would certainly explain her beliefs and behaviours over the years.
Interesting story!
Well, people who are delirious might say anything, but I think it’s in some ways similar to what people say or do in their dreams. A lot of it relates to fears, and then some of it might relate to something that’s on the person’s mind and now can bubble up. A well-functioning and normal brain actually expends a fair amount of energy deciding what’s appropriate to say and controlling that, and also can reason with fears to keep them from getting out of control. All of those functions decrease or disappear when people are delirious.
I think it’s hard to say whether your mother’s comments about another child were invented versus a truth that finally was able to come out. Either seems plausible…although honestly having a previous secret child sounds like an unusual invention. Good luck sorting it out and supporting your mother.
Thank you Leslie,
I will discuss with my brother to see if we want to do a search.
Best wishes.
E
My 80 mother has been hospitalized twice in the past 2 weeks with pneumonia and a uti. She also has a diagnosis of dementia, but usually is just a little forgetful. She didn’t seem to know where she was at times. And pulled out her iv once. She called me the first night she was in hospital demanding that I come get her. By the time of her second discharge she was doing better. She was not sent home with oxygen because her level was staying at 92, in the first visit she was sent home with oxygen. I took her back to the assisted living/ full care facility that she’s been living at for over 2 years. She has been out of the hospital for 3 days now and does not think she is home. She gets angry at me when I tell her she’s at her home. She constantly brings it up when I visit. Not sure how I should deal with that?
Sorry to hear that your mother’s been getting angry with you, that’s indeed very stressful.
What you’re describing sounds very typical for delirium making a person with dementia worse than usual. She will probably get slowly better with time, but it might take a while.
The difficult behaviors you describe (not realizing she’s home, getting angry at you) are actually not uncommon, they can be brought on by delirium but they also happen to many people with dementia, or they happen as dementia advances. So for help dealing with her behaviors and confusion, I would recommend reading more about how to cope with delusions and difficult behaviors. You basically need to remain positive, avoid arguing, redirect her, and so forth. There are some basic tips on the Family Caregiver Alliance website here: Caregiver’s Guide to Understanding Dementia Behaviors.
Good luck!
Sorry to read your story.
When my Mum had delerium she was physically violent toward my Dad and I but not toward my brother.
Thankfully it ended when the infection went. Hopefully your Mum will feel better soon.
My mother was in hospital for 7 days to cure Hyponatremia. Her sodium was dropped to 100 due to wrongly prescribed medicine.
She was doing ok mentally when one day she went into a space of fear chills sweat and stayed there for an hour or so. It started in last 2 days at hospital.
Ee brought her home and giving her best possible care but she is so weak that she can’t walk even with a cane. We use wheelchair to take her to bathroom.
When she sleeps ad wakes up (even after 5 minutes) she feels better, talk to us, stand with help or eat with her hand but like after 20 min she again goes to this confusion state and doesn’t come back unless she sleeps. It’s been 3 days she is back from hospital and we are extremelly worried she might not come back. She has hypertension and diabetes.
Well, 3 days is not a long time since she was back, it takes many people weeks or longer to significantly improve. She probably needs a lot of rest, it sounds like she gets mentally worse as soon as she moves around or is active for more than 20 minutes.
That said, if her sodium was recently low, you may want to ask her doctors if there’s any possibility it could be low again. That in of itself can cause confusion. Good luck, I hope she starts feeling better soon.
Hello I was wondering if you have noticed abnormal moaning when in pain or not for the elderly suffering from delerium. Thank you.
Yes, some older adults who are delirious will moan, as an expression of pain or discomfort or distress.
Moaning is pretty non-specific, though. (meaning, it can come up in lots of situations!) If you are concerned that an older person has delirium, the main symptoms are having difficulty paying attention and/or more confusion than usual, and it has to be a change from the person’s baseline mental state.
Evaluating for causes of moaning is very important in that we always want to recognize and try to address pain or distress. Any form of pain, constipation, fear, or other distress can be a contributor to delirium. Hope this helps.
I just wanted to thank you for this article.
My mother is 67 and lived independently. She even worked part time. She got a kidney stone which resulted in an infected kidney. The infection became septic and she ended up hospitalized in ICU. They decided to remove the kidney as she wasn’t responding to the antibiotics. After two weeks in ICU, she was finally well enough to go to a regular ward.
Only I noticed that she seemed very confused. She struggles for words, she “remembers” things that have not happened, and was hallucinating.
After reading this article I was able to articulate my concerns to the doctor as well as make changes myself to help her. It’s only been a couple of days but since then I believe she is making improvements. She has a long way to go but I am more hopeful.
Thanks again!
My 94 year old mother has survived the flu, pneumonia, and pulmonary edema and is now home still suffering from delirium. She was prescribed Seroquel and 37.5 mg at night and 12.5 mg during the day as needed. I don’t see a too much improvement in a little over a week and am wondering how long she can safely be on this drug. Is the drug meant to slow her revved up mind enough so her brain can heal and she can eventually be weaned off of it? Thank you for your time.
Sorry to hear that your mother has been delirious.
Quetiapine (brand name Seroquel) is an “atypical” antipsychotic. It is not FDA-approved to treat delirium but is sometimes used when a person is quite agitated and nothing else is working. Studies have found that antipsychotics can improve symptoms somewhat, but I’m not aware of any studies that have examined the value of an older person continuing the antipsychotic after hospital discharge.
In a 2017 JAMA paper on delirium in older adults, the summary states:
“Current recommendations for pharmacologic treatment of delirium, based on recent reviews of the evidence, recommend reserving use of antipsychotics and other sedating medications for treatment of severe agitation that poses risk to patient or staff safety or threatens interruption of essential medical therapies.”
We do know that it can take months for an older person’s delirium to resolve; I once saw a patient in his early 90s slowly improve over a full year.
In terms of whether your mother is likely to benefit from continuing Seroquel: we don’t know what the effect is on prolonged delirium, but we do know that older adults who are on antipsychotics have a higher risk of stroke and death.
I don’t know that there is any evidence that antipsychotics calm a revved mind in a way that helps it heal. They certainly are sedating, which reduces agitation and may be reducing stress levels.
I would encourage you to talk to your mother’s doctors about the antipsychotic. A general rule of thumb in geriatrics is that we want people to be on the least medication that is necessary, and we should only continue medication if it seems quite clear that the benefits outweigh the risks. Since the long-term benefits of continuing the antipsychotic are unknown, it would probably be reasonable to slowly taper it down and see how your mom does. Try to address any agitation or restlessness with non-drug methods, like soothing company, fresh air, a restful environment, and so forth.
You may find it helpful to read this article on medications for difficult dementia behaviors (delirium can cause similar behaviors), since it covers antipsychotics and also non-drug ways to mitigate behavior: 5 Types of Medication Used to Treat Difficult Dementia Behaviors.
Good luck, I hope she gets better soon.
MY mother has just had bypass surgery at 65. She had 5 bypasses. She was on a ventilator for up to 3 days after surgery and on day four became very paranolid that the hospital staff were trying to poison her. This is day nine and she is still waxing and waning. She does know who we are but is unable to speak very clearly. She seems very confused and unable to rest. Please send any information that would help us to better help her.
Sorry to hear of your mother’s condition. All the information and resources I have are listed in the article above.
Basically, your mom’s healthcare team needs to keep checking for delirium triggers and contributors (infection, pain, constipation, dehydration, medication side-effects, electrolyte imbalances). And then she otherwise needs supportive care so that her brain dysfunction can resolve. So she needs rest but also exposure to daylight, some physical mobilization if possible, her glasses and hearing aids if applicable, and reassurance. The presence and involvement of family members often helps provide this type of support and reassurance.
I hope she feels better soon.
Is buspar an appropriate medication for dilirium? My father is better during the day taking little naps but becomes more vocal and is not sleeping at night. Two nights ago he did great but then was up all of last night yelling help and trying to pull his catheter out. They had started him on the buspar medication a couple of days ago as well as melatonin. Thanks for you help.
Buspirone is a medication for anxiety. It is not a benzodiazepine or typical “tranquilizing” kind of drug.
I’m not aware of any recommendations that it be used for delirium or agitation. I myself don’t prescribe it very often.
Some people do experience agitation or insomnia with this medication, so you may want to ask your father’s doctors if he might be responding badly to the medication. Otherwise, it is common for older adults to develop more confusion in the afternoons, in part because that’s when people tend to get tired.
Good luck, I hope your father starts feeling better soon.
My mother was admitted to the hospital with pneumonia the beginning of this past month and just after her release, she was still having difficulty breathing. She’s had COPD since I was 9 then diagnosed with emphysema in 2014. I’m 43 now. She’s76. I got an urgent call to the ICU-she went into acute respiratory distress they had put her on a ventilator, intubated her, restraints in a medically-induced coma for 5 days. Her blood ox was 72%. Since then she has been belligerent, absolutely cruel going after everything from my divorce to my physical appearance. She’s now vilifying my boyfriend using vulgar language at me. The nursing staff actually winced at some of what she said to me and faked that visiting hours were over so I could have an “out. Mom was diagnosed with histrionic personality disorder and cyclothymia when I was 9 or 10 and it wasn’t until my father died 3 years ago that I realized how much he ran interference for us so she’s already predisposed to some negative antics. I love my mom and I’m the only child since my brother’s death. We’re the only family we have left. Tonight I was going to bring some clothing items she requested to the rehab facility they just transferred her to and she called me a bunch of expletives then hung up on me. It wasn’t the first time. I sent her a text saying that I was a person with feelings too and as long as she was going to curse at me and hang up on me I could not continue to do this tonight because my nerves are fried. She does have hearing aids but hers are not working and I have been looking all over the house for the little box containing the spares and I didn’t realize till I read your site how frustrating that must be for her. I sent her a text saying that I was a person with feelings too and as long as she was going to curse at me and hang up on me I cannot do this tonight because my nerves are fried. I lost a house to foreclosure in April, in March I had to have a tenant arrested for getting physically aggressive with me, in May I was involved in an auto accident that put me in the hospital for 12 days which prevented me from going to my storage space to reclaim my belongings and I lost over 20 years of my property because they disposed of it. So I’m under a lot of stress and she is sharp enough to use these experiences along with the failed marriage almost 4 years ago (he upgraded didn’t he?) to berate me further. I just wondered if there’s a correlation between viciousness and reactions to hospital delirium or how much she really is out of it and if it could be from the oxygen deprivation she suffered be for being put on the ventilator. Sorry this is so long I am guilting myself for not rushing over there with familiar things and photographs as recommended but she just decimated me tonight and I really needed a break. She never responded to my text except with a sarcastic Mother’s Day meme of her own. So slowly destroying me. Being a caregiver for my dad who was 21 years older was nothing like this Alzheimer’s and all. He got cranky but not vindictive. Am I alone in this?
Yikes, sounds like both you and your mom have been through a lot!
No, you are definitely not the only person to be struggling to help an older parent who says very hurtful things.
You should definitely take a break and protect yourself when it feels needed. Try to not feel guilty. Join an online caregiving community (this one is quite active) for moral support and encouragement on taking care of yourself during this difficult time.
Yes, you want to help your mother, but my general take is that no person should have to risk significant harm or emotional hurt to help an older parent.
If she has a difficult personality or is prone to wound you, then you’ll have to find ways to help and care while still maintaining some healthy boundaries. A very good book on how to do this is “Coping With Your Difficult Older Parent: A guide for stressed-out children.”
In terms of the correlation between delirium and viciousness: both delirium and dementia can cause “disinhibition”, meaning people end up saying or blurting out all these inappropriate things that they previously knew better than to say. So some people can become more of their negative self. In other cases, people’s personalities seem to change quite a lot, with previously mild and kind individuals behaving very differently than before.
If your mother has always been “difficult”, then this is probably delirium making her worse than usual. I would still recommend the book on Coping with Your Difficult Older Parent, since you will likely be in some type of caregiving/support role for the rest of your mother’s life.
I also highly recommend finding a support community. (The online ones are convenient if you’re busy.) Don’t attempt this alone, it is too hard and you need to connect with others. You will see that you are not the only one going through this. You’ll get ideas on how to cope and reminders to take care of yourself, so I can’t recommend support groups enough. Good luck!
My nan went into hospital for a routine infusion for her arthritis I believe. Half way through it was stopped as she began feeling ill.
The following day in hospital she started having delirium. She was sharp of mind beforehand. The first week she was able to reflect on these extreme episodes, which tended to start in the evening but she has gradually gotten worse and is current mumbling away and not sleeping.
Last week she was able to identify everyone in a photo album.
A few days ago we were not able to wake her and discovered the hospital had increased the anti psychotic drug. She was rushed away for an hour and deemed critical although the following day she didn’t seem too bad.
The hospital said that they couldn’t find any infection. Then they diagnosed her (4.5 weeks later) with delirium and masked dementia after testing where she scored 13 out of 30. We did not agree with the dementia diagnoses.
A few days later they were suggesting to test for a brain infection through a lumber puncture. The latest diagnoses is scarring to the brain. She had a brain scan a few weeks ago and this wasn’t mentioned.
We wanted to take her home last week but we’re told it’s not possible. The hospital are pushing for us to put her into a dementia home. Before hospital admittance there was nothing wrong with her mind.
Please give me some advice
Writing from Ireland
Sorry to hear of your situation and sorry for delayed reply (some of the comments were misdirected in the system and so I’m finding them quite late, argh!)
As I’ve mentioned in previous responses, if her mind seemed pretty good before her illness, that improves her chances of eventually recovering. But, the recovery can take quite a long time.
I do find that being home is often better, but helping an older person recover from delirium can be very labor intensive for family and not everyone is able to provide the necessary care.
I hope at this point that she’s gotten better. Good luck and take care.
My mother is 94 and was diagnosed with mild Alzheimer’s 2 years ago. She wasn’t dealing well with living in her condo so she eventually agreed she would be better in a retirement home. Seven years ago she had surgery for stage 3 colon cancer and spent 3 weeks in respite care before going home. After getting home she entered a anxious depressed state (retrospectively may have been delirium). She eventually recovered after about 4 months.
Mom had been doing quite well in the retirement home but her appetite has been declining for some time. This winter I was sick a lot and wasn’t able to visit her very much although we spoke on the phone almost daily. Unfortunately she caught influenza in April, then fell a couple of times, then caught pneumonia. This resulted in several doctor and ER visits. Each time they sent her home even though she was very ill. Her dementia, weakness and appetite declined significantly. We took her out for dinner and to our home for dinner to try and boost her spirits and get her to eat when possible.
About 2 weeks ago I got a call from staff at Mom’s retirement home saying she was very ill, confused and could not figure out how to get dressed. With her agreement we sent her by ambulance to,the ER. They indicated that pneumonia was still present and put her on IV with antibiotics. Her dementia worsened and she was considered to have delirium. She has been in the hospital ever since and is very weak, not eating and needs lots of help with toileting. This is a barrier to her return to her independent living retirement home. My mom doesn’t know she is in the hospital, although we keep telling her she is. We have also tried to encourage her to eat with limited success. She did seem to be improving but after a conversation with a medical professional in her presence about her delirium, etc she has gone down hill, despite our daily visits and having a visit with our daughter and her 16 month great grandson.
She can’t remember where she was living previously, and although I think being there again might help, she can’t go back until she can dress and toilet herself. The options are moving her to an enhanced care retirement home for a short period in till either she can return home or be placed in a a nursing home. The cost of enhanced care would eat through her money very quickly and I am concerned about moving her more than once which even if she recovered from the delirium might set her back. The waiting lists for long term care homes in our area are quite long (up to 5 years), with the less desirable ones having shorter wait times.
Regardless she is sleeping a lot again, is very subdued, can barely keep her eyes open when we visit and is eating less and less. I am wondering whether she can recover or realistically if we should be prepared for the worst. I am her only child and it is very difficult to determine how best to support her.
Sorry that your mother has been so sick recently. I can certainly see why you’re concerned.
In terms of can she recover and what’s realistic to expect. At this point, she’s been unwell since April, so about 2 months. At her age, the longer one is sick, the weaker one gets and the longer it takes to recover. One is also very vulnerable to getting sick again easily, which it sounds like she’s done.
Could she recover? It’s still possible but even under the best more health-supporting circumstances (e.g. in a familiar low-stress environment with lots of loving support and minimum toxic healthcare exposures), it would probably take her months to slowly recover. I have only occasionally seen people her age recover, mainly under two types of circumstances. The first is when the older person goes home and has devoted family with a lot of time available to take care of them. (This is not feasible for more families to provide.)
The other type of circumstance that sometimes helps older adults heal is, paradoxically, to enroll in hospice. Why? Because hospice tends to bring lots of supportive services and attention to symptoms, and hospice de-emphasizes the type of medical care that in principle can extend life but in practice is often quite toxic to frail older adults.
(I explain hospice, esp for dementia, in this article: Hospice in Dementia, Medications, & What to Do If You’re Concerned.)
I don’t suppose you previously had a chance to talk to her about what she’d want to prioritize, if she were quite sick and it was unclear whether she’d recover?
If she’s still in the hospital, another option you can consider is to request a palliative care consultation. They should be able to help you think through the “big picture” of her situation, and your options.
Hope for the best, prepare for the likely and quite possible. I think you are doing all the right things. She is sick but you are making an effort to be present and to advocate for her, that’s what’s most important. Good luck and take care.
My 81 year old father had surgery for spinal stenosis 12 days ago. He was discharged from hospital into “step down care” a week ago and has been going downhill since then. The past 3 days he has been showing signs of delirium – last night he thought there was a mad person on the loose in the hospital (i got to the root of this – a woman in the room across from him was in a bad way and moaning and shouting and his mind clearly ran away with him. Once i explained what was going on he was back to normal) I went this morning and he told me that he spent the night locked in the basement and covered in water… when i tried to explain to him that he must have been dreaming he got quite aggressive about it. The doctor says he’s refusing to do his physio and when i tried to talk to him about it he claims that he’s fine and doesn’t need it. He also told me that i need to learn to listen to him otherwise i’ll ruin my life (!!).
He has had previous post op delirium after a knee replacement about 4 years ago so i guess this was not wholly unexpected but i didn’t realise it could take over a week to start. He does have an infection of some sort (they suspect UTI) for which he’s getting IV antibiotics so i’m hoping that once this clears the delirium will go away. Any thoughts around this would be appreciated as i’m hoping this stops soon, i’m actually scared to go and see him as it’s so nerve wracking not knowing what you’re going to be faced with.
I feel for the previous poster EJ as my father is a very difficult selfish person even when he is himself – so much so that we think he’s actually a sociopath. In his current condition he’s very hard to deal with and i believe the last time it happened (i was overseas at the time) he said some terrible things to my mother which upset her to the extent that she never really got over it (she passed away 2 years ago) so i think that sometimes when people are challenging in their normal state that the delirium accentuates this and brings out their dark side.
All he wants to do is come home and won’t listen to reason and threatens to discharge himself. I have a home nurse on standby for when he is discharged and i’m hoping that once he is out of the step down clinic things will improve.
Sorry to hear of your father’s condition. Yes, delirium can start several days after surgery, for a variety of reasons, including a new infection as may be the case for your dad.
And yes, it can be very stressful to visit someone who is confused or saying upsetting things. If possible, try to remind yourself that this is the illness and not really his fault. (Even if he has a difficult personality, that is probably not his fault; such personalities are usually due to difficult childhoods or genetics or both.) It probably is good for him to have familiar people visit, but if possible, try to avoid arguing or trying to reason, and instead just try to be soothing.
This is of course very taxing, so get some help and support before and after these visits! I hope he improves soon. Good luck!
Thank you. He was discharged from the step down facility day before yesterday and came home (I had home care set up). He wasn’t in great shape but the doctor had said he was fine to go home as the infection was clearing. Yesterday afternoon I had to call an ambulance as he had deteriorated to such an extent and he has been readmitted to hospital with pneumonia and a severe UTI / kidney infection among other worrying test results. I think the delirium must be related to the infection as he thought he was in hospital for his knee operation (which he had 4 years ago).
So we are back in square 1. Poor dad.
Yes, if he has infections that is very likely a major contributor to his delirium. Hope he gets better soon!
Hi,
My father (age 86) developed delirium following a partial hip replacement the end of March. The wound became infected and he had a second surgery (I&D) the middle of May then went to a Skilled Unit for 6 weeks for IV antibiotics. He discharged home June 25 unable to stand, turn himself,etc. We purchased a stand assist and he has progressively gotten stronger to the point that he was able to use his walker and walk approx. 20 feet this morning!
However, while he is physically stronger, he continues to be confused at times, especially at night, constantly yelling and calling for help, insisting he needs to urinate (he has an indwelling catheter for retention) and saying mean things to those around him. He attempts to get out of bed and becomes angry when attempts are made to reorient him.
We have eliminated medications which are not absolutely necessary ( ie. stool softener,meds for acid reflux, etc) and he is now just taking what he was on prior to his fall and surgery. ( Dig, Keppra, Lopresser, synthroid, etc.) We play soft music at night, adjust the lighting, etc. but he continues to keep everyone awake. He doesn’t remember any of this in the morning and appears to be adequately rested (he naps during the day). Do you, or any of the readers, have ANY suggestions of additional ways of how to deal with the night time issues? No one is getting any rest and I am concerned for my mother’s health (age 84). I keep thinking this has to get better soon but….
Hm…what you describe sounds a bit like sundowning and/or the kind of sleep problems that are common in dementia. His circadian rhythm may be a bit off, esp if he is napping during the day. I have an article on sleep and dementia, some of the suggestions there might help…even if he doesn’t have dementia, doesn’t sound like his brain is entirely back to normal.
How to Manage Sleep Problems in Dementia.
In particular, I wonder if it would help to make sure he gets plenty of exposure to light during the day. You might also want to ask his doctor about melatonin, it seems to help some older adults with their sleep schedule. Good luck!
My 71 year old father has been in hospital with delerium.now for almost 3 weeks wit no sign of improvement or diagnosis. They have ruled out UTI, meningitis, septis, any cancers, and all his vitals are performing well. As well as clear CT scan. He does suffer.from Stage 4 heart failure and has type 2 diabetes. He has experienced foggy moments over the past year and some paranoia BUT nothing to this extreme. Before I admited him he was also vomitting. His mother suffered from dementia and now this is being thrown around. .. Any thoughts?
Sorry to hear of your father’s delirium. It does seem to persist in some older adults, even when no obvious infection or trigger can be found. It’s possible that being in the hospital is stressful for him and is affecting his ability to start to recover.
In terms of the possibility of dementia: we do know that many dementia processes damage the brain for 10-20 years before symptoms become obvious. The stress of hospitalization and delirium can “unmask” an underlying dementia. If he’s remaining delirious, it’s certainly quite possible that he has a vulnerable brain that may have some underlying changes or damage. He does need to be given a chance to recover before being diagnosed. But in people like him, there is a fair chance of being eventually diagnosed with dementia over the following few years.
For now, I would recommend you focus on helping him recover. Good luck!
My entire family is exhausted. Nothing works with my MIL. She is 92 post stroke with dementia. She was in rehab and then a nursing home but kept falling by trying to get out of her wheelchair. Of course, the no restraints policy meant that if someone was not right in front of her the entire day just taking care of her alone, she would fall. She was only in the nursing home for a week and fell 5 times. This was with me going every day for two hours and a sitter for two hours every day. The fifth fall broke her hip, so she is now in the hospital trying to yank out her IV. We are desperately trying to find sitters so someone can be with her 24 hours a day. My SIL has already been to the ER for stress-related heart problems, my husband’s IBS is flaring, so guess who will soon be taking 16 hour shifts with a screaming, flailing, crying MIL? The overworked nurses act as if they have never dealt with this before, the hospitalists have too many patients and may visit every other day. But it’s rarely the same doc, not her internist, and you never know when he or she will be there. They refuse to give her Clonapin for her anxiety, which in the past is the only thing that has worked so both she and we can get relief. If this situation continues, we will ALL be in the hospital together. Whoever wrote the new guidelines obviously never had an elderly parent. The nurses, doctors, nursing home staff’s hands are tied. There is no help, though everyone cares. Nothing can be done. I guess it will be like this until she dies. We have tried all your suggestions many many times just on our own before I even read this, but she is simply inconsolable. She never sleeps except 5 minutes at a time. This is HELL.
Yikes. That does sound pretty bad and extremely stressful.
This situation overlaps somewhat with managing agitation and other difficult behaviors in dementia. I write about the various medication options here:
5 Types of Medication Used to Treat Difficult Dementia Behaviors.
The guidelines are meant to provide a sensible starting point. Medicating agitation should not be the first step, but sometimes it’s necessary when all else has failed. Generally, if we have to use medication for this kind of agitation while hospitalized, we would probably try an anti-psychotic rather than a benzodiazepine such as clonazepam. This is in part because benzodiazepines cause paradoxical agitation in some older adults. I suppose if you know benzodiazepines have worked well for her in the past, you could ask that they give it a try, but it might be better to do the trial with a benzo that is shorter acting, such as lorazepam (brand name Ativan). It is also important to ensure that her pain is being adequately managed, so sometimes I try pain medication before a tranquilizer.
Of course pain medication sometimes makes older adults delirious as well…which is why we start with guidelines and then have to proceed with careful and sensible trial-and-error.
You are right that sometimes, everyone cares but a decent solution remains elusive, and this can feel hellish for families. All I can say is keep trying and keep asking the providers for help. You may need to remind them that the sensible first-line approaches have been tried and haven’t worked, in which case it may be reasonable to try second-line or even last-resort approaches.
You could also try requesting a palliative care consultation, if you haven’t already done so. good luck!
Thanks for the informative article, it should be required reading at all hospitals. My father-in-law is 80 and was recently diagnosed with Multiple Myeloma. He was undergoing treatment at home and while he was very fatigued, he was eating well and moving around on his own. His bloodwork numbers were improving, but unfortunately he had to go to the hospital for fluid in the lungs and they inserted a chest tube.
He has since recovered from that (tube has been removed) but is now in a skilled nursing center due to the inability to sit up or stand on his own. He is not getting good rest or eating well and is very confused. Prior to going into the hospital he had been diagnosed with the very initial stages of dementia, but I can tell you he was clearer than most eighty-year old men.
We feel strongly he would be much better at home and are trying to set up 24/7 home healthcare to make that happen. However his facility says he is too weak for that. Our concern is the longer he stays in the worse he will get. We are thinking about hiring a patient advocate to ensure he gets the best treatment possible.
My question is wouldn’t it be worth it getting him home with full-time care for a period of time to see if he responds any better? Is weakness a medical reason to keep us from doing that?
Thank you in advance.
It’s true that many older adults find it more restful to recuperate at home, provided that the family is able to provide enough assistance with managing daily tasks, if necessary. If a family prefers to take someone home, it’s often possible to manage any needed skilled nursing care or therapy via home health services. Weakness, in of itself, isn’t necessarily a contraindication to going home, provided there will be enough help at home.
A patient advocate can help sort these issues out, so that might indeed be a good avenue to pursue. You can also learn more about your family’s rights via these resources:
Medicare Part A coverage—skilled nursing facility care (Medicare.gov)
Next Step in Care: Rehab Facility to Home
Good luck!
I am so relieved to find that this is real!! I had knee surgery with complications and had an episode where I thought I was being held captive on the psychiatric floor of St Luke’s Hospital in Houston. Called the police, EMS, my son etc. It was horrible and REAL. I still cannot believe that it was not. They said it was due to severe blood loss.
Yes, this is definitely a real phenomenon. Sounds like you recovered, glad to hear it.
Unfortunately, having had delirium in the past puts you at increased risk for having it in the future. So if you are planning another elective surgery, you may want to talk to the doctors proactively about how to minimize your risk for delirium when you have the surgery. Some hospitals have better programs or facilities for this than others do. Good luck!
My 80 year old father had a heart attack and spent 3.5 days tubed and sedated, 1.5 days after before being moved out of ICU. It’s been a few days since he’s been off sedation drugs, but delirium hasn’t subsided. I assume it takes time, but fear it may delay his recovery. I couldn’t find it mentioned anywhere, but would it be helpful to tell him he’s experiencing delirium, and provide him with reading material on the subject? My hope would be faster recovery, but certainly wouldn’t want to compound the problem.
Sorry to hear of your father’s delirium. Yes, it does often take time for people to slowly recover.
Yes, generally it’s recommended to let the older person know they’ve had some delirium. People can be very frightened by their symptoms and may worry that they are going crazy or losing their mind. So it can be a big relief for someone to tell them that it’s ok, they’ve had confusion or hallucinations but that’s because they were sick and now it’s getting better. You can also ask your father’s doctors for help explaining the delirium to him.
That said, don’t insist on explaining delirium, especially while he’s delirious or if trying to explain this makes him more confused, anxious, or distressed. You really want to focus on creating some reassurance. Giving him reading materials might be tiring and confusing. I would think just giving a little brief information and reassurance would be best. Don’t overwhelm with information. People recovering from delirium need rest and reassurance so that their brains can recover.
Every person is an individual, so you may have to do a little trial and error to find out what works best for your father. Good luck!
Thanks Doc. He had great progress yesterday, but last night was sleepless and confusing, and today it’s like a step backwards. We’ll keep reassuring him as best as we can, and hopefully once he’s released home to a familiar environment he’ll snap out of it. Thanks again!
Hello, and thank you for such an informative site.
My 82 year old Mother has had a difficult year. She’s had three general anaesthetics in 9 months for hydrocephalus, a fractured hip and most recently, her gall bladder. After her brain surgery and hip surgery, she experienced severe confusion during her hospital admissions that slowly settled after she came home (-although it took several months). She recently had a short hospital stay for a cholecystectomy, and given her previous history the medical staff were fantastic in ensuring she wasn’t over-medicated. Upon being discharged from hospital nearly 4weeks ago, she was a little ‘muddled’ and very weak, but generally not too bad compared to her previous experiences. But I’ve noticed over the last few days that her confusion seems to be increasing. It’s not immediately apparent, but conversing with her tonight made me realise she actually didn’t know that I lived with her, among other things. I will make an appointment for to see her regular doctor, but is it possible for Post-op confusion to escalate a month after a hospital stay, or fluctuate? Thanks so much for your time, and regards.
So, it’s common for symptoms to fluctuate somewhat with delirium, but usually the fluctuation happens over the course of a day. A person might also be worse on one day compared to the other, just because they didn’t sleep well.
However if these days she’s noticeably worse than she was a week ago, or if you’re noticing a trend in the wrong direction, it would be reasonable to be concerned that she’s becoming more delirious again, and hence one should consider evaluating her for a new infection or some other kind of new trigger.
Another possibility to consider is that maybe she had hypoactive delirium after the hospitalization, which makes people quieter. Now that she’s stronger and more verbal, you might be noticing some underlying confusion…this could still be her resolving delirium, and she might also just have developed a worse mental baseline after this year of hospitalizations.
It is possible that a search for triggers won’t uncover anything treatable, but if you think she’s worse than she was a few weeks ago, it’s probably worth bringing this up to her doctors and having her checked. Good luck!
My 67 year old father recently got diagnosed with a bacterial infection at the spine. He was on intravenous Vancomycin for a period before being switched to Clindamycin. After showing signs of improvement in the hospital he was sent home with a month’s course of Oral Clindamycin. He is also on Tramadol as a pain killer. A few days ago he started hallucinating, seeing and speaking to people who were not around. All doses taken as per instruction from the hospital. Physically he seems to be recovering.
I’m not sure if this is classified as delirium and am looking for advise on whether to worry and take him back to the hospital? Many thanks!
This does sound worrisome. If he wasn’t hallucinating before and then developed hallucinations and confusion, this certainly could be delirium. I would recommend alerting his usual healthcare providers and asking for assistance. Good luck!
Hello I am writing this comment because I am lost and depressed with my family situation. Two months ago me and my mother were playing video games. All of a sudden she ran to the bathroom and vomited violently. When she came out she was dazed. She sat down holding her head and said she was feeling fuzzy. Then she didn’t remember who I was or who anyone was. She didn’t even know herself. Concerned we called 911 and she was taken to the hospital. In there they found her potassium was critically low, her sodium was low, her electrolytes were out of balance, severe dehydration and a UTI.
While in the ER she kept repeating herself, “why am I in the hospital, how did I get here” over a hundred times. It was clear she had to stay over night. So they kept her there and treated her medical condiotions for several days. While treating her they looked at her medication where she is taking serequel and prozac for depression, anxiety and sleep.
At first the doctors didn’t know why she was confused and tried to tell us that it maybe permanate. They didn’t beleive me when I told them that her IQ and normal baseline was above average and that she at one point in her life attended college. It wasn’t until a few days later after giving her antibiotics and potassium that her condion improved and she remembered who we were. They took her off of the seroquel because they blamed that on her part of her condition.
Then they released her and told us to continue giving her antibiotics for the infection. However when she got home she was fine for a few hours, but then became confused again. She was laughing a giggling hysterically and acted like she was a child. We had to help her with her hygiene routine.
We were going to go back to the hospital in the morning but when she woke up she was better again. We took her to her doctors office and they did tests on her and said she was fine. However a few days later she became confused again, exactly like she was the first time.
We rushed her to the hospital again this time and she was found to have a UTI. I was angry, how can she have one when her doctor said she was clear? Clearly the infection didn’t clear up.
They kept her for another two days until she was fine again. Since then she was ok however she followed up with the neurologist that saw her and he said her brain activity is sluggish. They want to do more tests and to follow up with him in a month. We also took her to her psychiatrist who was angry about her being taken of her meds and said she worked as a doctor for many years and knows that it wasn’t the medicine.
However what is strange is a few days ago she became confused again out of nowhere. We planned to take her back to the hospital, but she was suddenly fine again after taking her seroquel.
Lately she has been mostly herself, but she had trouble remembering things sometimes or concentrating on tasks. Sometimes she may forget she told us something and tells us again.
I was wondering if her medicine could have been the real cause or perhaps the UTI? Also I was wondering what her sudden confusion could be? It was strange that it suddenly went away after she took her medicine and went to bed and has been fine since. She is post menupause and in her late 4os almost 50.
How long does it take to fully recover from delirium like this and can they or will they have a relapse of it in the future? Is it something that she is going to have to live with?
Sorry to hear of your mother’s situation. So, if she is under 50, then she is much younger than my own patients and than most parents that people here have written comments about.
People under age 50 can get delirium or otherwise can become confused, but the likely causes are a little different than in much older adults. In particular, it would be unusual for just a UTI to cause delirium in a woman under age 50. So, it’s possible that she has something more unusual going on. Neurology is a good specialty for evaluating confusion and other similar symptoms. I would recommend you keep following up with them and keep asking lots of questions. Your mother’s psychiatrist may also be able to help. Good luck!
My husband is Stage 4 Parkinsons, 10 years dx. Two weeks ago he had double bypass heart surgery. He has been in C-ICU since. He suffered grave pulmonary issues two days following surgery and was reintubated for 7 days. Five of those days he was on propofol anesthesia. Then just fentanyl. After fentanyl was discontinued it took him 2 days to wake up. When he woke up he had delirium … and still does. They are working diligently on his coexisting pulmonary issues from surgery, his delirium and getting him stronger.
They are now giving him melatonin at night to help his night/day schedule.
Any thoughts?
Well, you don’t say how old he is, but he’s been very sick and also at baseline he has a mind that has been damaged by Parkinson’s. It will take time for him to recover. Melatonin is a reasonable approach to try to correct the circadian rhythm. Sounds like they are doing reasonable things.
If you or other family members can be a reassuring presence, that can help. Be sure to take care of yourself and get support for your own caregiving journey too. Good luck!
Is this possible outside of hospital inpatient settings? Although my mother has not experienced inpatient medical care, she’s had unreasonable/out of character (original character, not our new norm) reactions to medical procedures and some loss of brain function never returned. The worst of it is usually after the fact, once away from the facility. After some skin biopsies she flew off the handle so badly in the car (they they not only overwhelmed but hurt her) that one of the cauterized sites on her face starting gushing blood. Now we face possible radiation treatment and I can’t get radiation oncologists to meet with me separately in advance to come up with a workable plan. I’m so tired of dealing with medical professionals who don’t have a clue about how a simple office visit can be terrifying for her since she can’t comprehend everything and is incapable of reasoning. The word radiation alone could trigger negative thoughts since my father died shortly after his last round of radiation. Someone told her afterwards that new evidence pointed to radiation could make prostate cancer spread vs arrest its progress. She felt complicit in his death for encouraging radiation, even though they were following Dr recommendation & my father had done extensive research. Her last physical, done by her NP who is in her facility at least once a week, caused her to want to move out. She couldn’t relate anything beyond they took her blood pressure again and won’t leave her alone and just needed to get out of there. Is there something I could put in a note for the physician to read in advance? I fear if they hurt her, or overwhelm her, I may never get her back to complete treatments. Suggestions?
Hm. Yes, it is possible to develop delirium outside the hospital, it can be due to a new infection, a medication side-effect, an electrolyte imbalance, and other causes.
That said, it sounds like your mother is chronically cognitively impaired and also that she might be experiencing some type of anxiety or fear reaction, in response to procedures. Most people with dementia do get cognitively worse when they are anxious, and I have also seen some of them regularly fall into spirals of anxiety –> worse cognition –> even more anxiety & distress about what’s going on –> even worse cognition.
I think you are right to try to be proactive and reduce the anxiety and distress triggers as much as possible. I’m sorry but not surprised to hear that you are having difficulty getting the health providers to cooperate. Most of them are very busy and have limited capacity to make adaptations, even when those are clearly needed by the patient.
You can put your concerns in writing and if you do so, these often get scanned into the chart. But I also think that a health provider is most likely to listen if they speak to you (assuming you can get them on the phone). All of this takes effort and is tiring, as you rightly point out.
In terms of suggestions…first of all, if your mother has a habit of getting distressed by medical care, then this is a “burden” or downside that has to be considered. Every time you consider whether to proceed with a treatment or procedure, be sure to ask yourself whether the likely benefits outweigh the risks and burdens. Does your mom really need those skin biopsies? What would happen if she didn’t have them?
As people progress with dementia, a lot of routine care becomes more distressing for them. They also often become less likely to benefit, because their life expectancy becomes limited. So, it’s good to keep reviewing what is most important for your mother to get from her medical care, and what kinds of risks and burdens are worth tolerating.
Behavioral approaches are the safest and best way to manage anxiety spells or other difficult behaviors. We have an article on those here:
7 Steps to Managing Difficult Dementia Behaviors (Safely & Without Medications).
Otherwise, medications can sometimes help with anxiety. Be careful about the fast-acting ones (benzodiazepines such as lorazepam), they become habit-forming quickly and often make thinking and balance worse in older people. SSRI type antidepressants such as citalopram sometimes reduce anxiety, but they take 6-8 weeks to reach full effect.
Sorry once again that the medical system is making things harder instead of easier for you. Good luck and take care!
My 81-year old husband has Parkinson’s and had a total knee replacement surgery 5 days ago. He became delirious the day after surgery, convinced I was having an affair in another city with a prominent leader and the scandal was on the cover of Time magazine. Now, he’s convinced he’s actually at the airport, not the hospital, restrained by armed guards who have broken his knee. He has to be watched around the clock because he keeps trying to get out of bed. Normally, he has a wonderful mind (he is an emeritus professor) with no signs of dementia. I try to spend as much time with him as I can, but can’t be with him more than 5 hours a day or so. His son lives far away. His surgeon wants to get him into transitional care at the same hospital ASAP to receive extensive PT, but this is not possible in his current state. He takes a number of meds for his Parkinson’s,s, including antidepressants, Sinemet, Simbalta, and Diloxitine. He used to take Clonazapam occasionally but isn’t doing so in the hospital. the dementia seems to be getting worse each day. He has good caring doctors, but I’m very concerned about his recovery and what things will eventually be like at home.
Sorry to hear of your husband’s delirium. If he was mentally sharp before surgery, that improves his chances of eventual recovery. But as noted in the article and the comments, it can take a while for delirium to resolve.
Some hospitals do have special units designed for hospitalized older adults, and usually, they prioritize mobilizing people as early as possible. So even if he cannot participate in intensive PT, hopefully it will be possible to encourage him to move around safely.
Try to not argue or talk him out of any delusions; it’s better to be reassuring and non-confrontational.
Good luck!
My 71 yr old mother has always been a very independent and healthy woman who has had no previous medical history, no previous surgeries, is not on any medication and doesn’t even have a GP. She has always been a very active and can-do person. She has lived alone since my father died almost 15 yrs ago.
Recently she experienced gall bladder pain and had to be scheduled for surgery.
The surgery ended up being a complicated open surgery and she was in the hospital for a week instead of the two hours that she’d planned. Since then she has been admitted 5 more times for complications arising from the surgery including kidney failure and dehydration from falling so ill afterwards. She has spent very few days in the past 5 weeks at home. I have stayed with her for every minute of those hospitalizations and with her at her home to help to care for her.
During her last hospitalization she suddenly became agitated and aggressive demanding to know who I was. When I told her my name and my relationship to her she called me a liar and began to argue with me. I tried to calm her down and reason with her but it was clear that something had changed. She became paranoid, aggressive and even violent and it became worse over the next few days at the hospital.
I researched what was taking place and believed that she had hospital delirium. A few of her nurses agreed and as soon as she was well enough I had her discharged. I didn’t think that subjecting her to rounds of needless tests when she was in such a frantic state demanding to go home would do her any good.
Thankfully she did begin to improve almost the second that we left the hospital. Her aggression lessened, although it will still appear with a bit of paranoia at times. But overall we were making some progress.
We returned to a follow up visit when I realized that she probably had a UTI. She has been on antibiotics for a few days now. By the next day her behavior changed dramatically. She is no longer as violent and aggressive. Her confusion has not fully gone away but she does not try to hit you when you say something that she doesn’t agree believe. (Which is, of course, something that she never did before.)
I’m concerned about her loss of skills and memories, though. It has been about a week since her discharge from the hospital and four days since she started her antibiotics. She seems to know who we are but she still talks about people who aren’t there and forgets things that were just said. She also doesn’t always remember that she owns the house that she’s in and has lived there for 40 yrs. She keeps wondering where she’s going to live and how she’s going to take care of herself. She’s forgotten how to use the remote control, the computer, and sometimes the cell phone. Are these skills that will likely come back to her in time or should I be worried that there may have been something else that happened to her (stroke).
Thank you so much!!
Sorry to hear of your mother’s recent health challenges, it sounds like she has been through a lot! Great that she seems to be improving now, however.
It can indeed take weeks or even months for an older person’s brain and thinking to fully recover, after an episode of significant delirium. Stroke is not usually considered unless there are significant neurological signs, such as asymmetry in the face, slurred speech, or weakness on one side. (If she has high BP or other stroke risk factors, consider getting those medically optimized, but that is for her long-term health and not to improve her situation right now.)
Good luck!
Thank you so much for you help. I have been so stressed and at a loss to know what to do to help her through this new medical situation.
Are there any suggestions that you can give me that can help to improve her now that she is home? Most of the articles that I’ve come across deal with currently hospitalized patients.
I have tried to recreate her environment pre-hospitalization as much as it is possible. Instead of taking her to my home, for example, I have taken her to her home although often she does not recognize it. I also try to rein in my impulse to do too much for her now that she is physically capable of doing things for herself. I am torn between fearing that I would hinder her progress if I do too much for her or if I am pushing her too hard in allowing her to get her own drinks. I am also trying to wait patiently for her to remember words for her sentences instead of supplying them. Also, does it help or harm my mother when I remind her that I’m her daughter instead of her sister or that she has two different people exchanged in her mind?
I’m so sorry for all of these worries at once. I feel as if I’ve dumped so much on you at once, but I feel as if I’ve been swimming in mud for weeks now with no real answers and I would certainly appreciate you help and guidance. Thank you so much!
Sorry to hear of your situation, even though it’s great that she’s been able to leave the hospital, it can still be quite stressful to have an older parent remain confused for days or weeks.
It sounds to me like you are doing all the right things, in that you’ve brought her back to a familiar environment and you’re encouraging her to do things for herself.
Re whether or not to remind her that you’re her daughter, I would say try one approach and then the other, and continue with whichever one leads to LESS agitation or stress for her. If correcting her mistake seems to upset her, then stop. If she’s accepting of the information, then it’s probably ok to correct her.
You don’t say what she was like before. Is she slowly improving now, or has she stayed at the same level of confusion for weeks? Most older adults will slowly get better (but may not get quite back to how they were before). So it’s really a matter of time and patience. It IS a real strain to take care of someone who is confused, so if you are very stressed, see if there is any way for you to take some kind of break from the situation, or otherwise restore yourself. Older people often do pick up on the stress of their family caregivers, so taking care of yourself can help her recovery. Good luck and take care!
My mother had lung cancer removed on November 20, 2018. She did great came home 3 days later on the 23rd. Unfortunately on the 27th she woke up completely confused and I took her back to the hospital. She was diagnosed with pneumonia and a UTI and was kept in the hospital for 10 days. I kept telling the staff something was wrong with my mom I asked the doctors about her meds and could it be something they were giving her because she still wasn’t herself, One Dr told me she was just severely depressed and would be okay but this wasn’t ever how I knew depression to be my mom just wasn’t right. Another one of her doctor’s after I pressed them to figure out what was going on said he believed it to be hospital delirium, that it would get better once she left the hospital. So they released her on Dec. 8th. Took her home and she stayed confused. I took her to her PCP and they ignored the fact she wasn’t okay mentally. Until the last day of Dec they diagnosed her as having severe delirium. We are now almost 2 months into this and she has only had about 15 good somewhat clear days. She seems to get better for 5 days and then completely goes down hill back to total confusion. The Dr claims this is normal for delirium patients that its a rollercoaster ride, but how do you go from getting better to right back on the ground worse. Before all this my mom was completely independent and driving, cooking, traveling and all. Now she has to use a walker and falls every few days, no longer drives and no longer does anything she use to. She did a complete 360 after surgery. Can delirium last this long? Or should I be looking for another diagnosis? I feel so lost and desperately trying to help her. I am losing all trust in the medical field because of all of this.
This does sound like a tough situation. At this point, she’s only been discharged for about a month (since Dec 8). It can take months for some older adults to improve, so she may just need more time to rest and recover. I’m not sure why she seems to get much worse every five days although there certainly can be some up and down with good days and bad days. Usually, if there is a sudden worsening, we check to make sure there isn’t a new infection or other medical stressor.
It sounds to me like you and the doctors are learning through some trial and error. If she gets evaluated a few times after suddenly getting worse, and nothing treatable turns up, then yes, they will probably attribute this to slowly resolving delirium, and they’ll stop thinking they need to check in detail when she has another day of being worse than usual. This could just be her pattern, or maybe she is responding to a poor night’s sleep or something else that is interrupting her slow recovery.
I’m sorry I don’t have anything more definitive or satisfying to share. It’s not clear to me that you should be looking for another diagnosis at this point, but if she seems sick or unwell, definitely get her re-evaluated.
It can be really hard to keep watching and waiting for things to improve. And of course, it can be hard to know when something new is wrong, with all this up and down. Get some extra help and support from other family members and friends if you can. Good luck, take care, and hang in there!
Thank you for this forum. I have been reading these comments all evening and they have calmed me greatly. My husband is a type 1 diabetic for the last 44 years, diagnosed at 4 years old. He has retinopathy and is legally blind. He can see but is definitely visually impaired. He has degenerative disc disease and a herniated disc, recently diagnosed with spinal stenosis. Two weeks ago he severely injured his back somehow at home, we suspect moving some heavy furniture. He was unable to move at all without screaming, laid on the couch for a week. I was trying to help him but didn’t have the strength to get him up and down very well. He actually hit his head on the wall in one instance of trying to get him back on the couch. So after four ER visits to one hospital, where they refused to admit him and just gave me cipro antibiotic and flexeril, dilaudid iv for pain, we noticed some hallucinations at home. Did some research and found flexeril can sometimes cause this, so we discontinued use. Symptoms only got worse so we took him to the other local hospital and they finally admitted him for the back problem. After one day in the hospital he developed delirium. Doctors discontinued all drugs as well as the steroids they had been giving him there. He improved greatly after a few days, so the gave him Zyprexa and sent us home with a 7 day regiment. Day 1 out of hospital he seemed himself again. Back pain is still severe but improving. Day two and three delirium symptoms have returned at home, to the point where he was livid that there were people in our house stealing his stuff. We have stopped the Zyprexa and are waiting to see if his symptoms resolve again. Any advice on how to care for him would be greatly appreciated. I dread taking him back to the hospital as I know it will cause him to rapidly slide back into delirium faster. He has been spiking a fever every once in awhile but they checked him for infection, cat scan, mri, and eec to check his brain before discharge. All other medications have been discontinued except Percocet which he has taken for pain twice a day for at least two years.
Thank you so much
Jess
Sorry to hear of your situation, it sounds quite difficult.
Your husband is not an older adult, he is 48. I don’t have any experience with long-time type 1 diabetics of his age. Generally as people get older and more physically vulnerable, it’s easier for them to tip into delirium when ill or physically stressed by lack of sleep, medication side-effects, etc. Whereas for younger people, it takes a much more severe illness to cause delirium. I would recommend making sure he is carefully checked for infection or illness. Good luck!
So he spiked a fever at home. We were unable to get it to go down at all. After a few days we took him back to the ER, they sent him home with an antibiotic. Fever still wouldn’t subside so we took him back and they admitted him. Found out today he has bacteria in his blood. Still not sure what kind. Of course he is hospitalized and his delirium has returned today, as I had to return to work. I have used every available vacation hour and can not afford to miss anymore work. I am terrified and at a loss as to what to do. This is a terrible illness.
My 79 year old mom fell at Thanksgiving and hurt her back. She was in rehab for a month with no problems delirium related.
This past Friday she was bending over to get books out of a drawer and she fell again and broke her wrist.
She was given two IV doses of morphine and something in pill form at hospital. While they were wheeling her in for surgery the next day, her heart started racing and her breathing became shallow. They cancelled surgery and set her arm manually. Her co2 level was 75 and they transferred her to ccu and gave her a mask.
Next they ran tons of tests on her. They diagnosed copd, a uti, which she is diagnosed with every time she goes to the doctor and a sinus infection.
Up until the mask on Saturday she was not delirious. She started the confusion while on the mask which she pulled off at 2 in the morning and would not allow back on. The next 48 hrs she was combative, confused and did not know anyone. It is Tuesday now and she has calmed down, but doesn’t respond much and is very tired. She will sometimes not know names.
Is this the pain meds and hence co2 elevation, pain, lack of sleep, copd? We did not know she even had this.
I am furious because my mom finally fell asleep which she desperately needs and rehab people came to do exercises.
The doctor does not seem very concerned and wants to release her to the rehab facility tomorrow.
Only Tylenol and Tramedol, but also a pill for relaxation and anxiety is given to her along with an antibiotic.
Her co2 is down to 60 which is still very high from what I can tell.
Shouldn’t the doctor be more concerned at this point?
Thank You for reading this!
Sorry to hear about all these recent health complications, it sounds like your mom has been through a lot over the past week.
I really can’t say whether the doctor should be more concerned or not, it’s impossible to know from a distance. I will say that even though she didn’t experience any delirium during her previous rehab stay, she may have experienced more illness and stressors this time around and that may be why she experienced delirium. Having a high CO2 level can also affect the brain.
Medications such as tramadol and also “pills for relaxation” (which are often benzodiazepines) are usually avoided if possible by geriatricians, because they can make confusion worse.
If you are concerned about her CO2 levels — or really any aspect of her healthcare — I would recommend asking more questions of her health providers and getting them to spell out what they are doing and thinking. Hope she gets better soon, good luck!
My father is 3 weeks into alcohol withdrawal at the hospital and it’s not going well. He is 79 and not in the greatest health, although he has no major illness. He simply won’t snap out of his delirium slumber/sleepiness. He has had a few moments where he wakes up and is aware of us in the room, makes eye contact and tries to talk (but can’t really), but otherwise he is asleep all day. The doctors are suggesting we remove support – remove his IV and O2 nose piece – presumably to accelerate the dying process. They have seen this more than us obviously, and insist he is palliative. But it’s hard to give up on him as there isn’t anything REALLY wrong. His vitals are all ok. Don’t know what to do, but giving up on him seems cruel given that some people do spends weeks in delirium related to alcohol withdrawal, and then come out of it.
Sorry to hear about your father’s situation. Hm. If the doctors are “insisting he is palliative” but you feel there isn’t anything “really wrong”, then it sounds to me like there’s been a communication breakdown somewhere.
It doesn’t happen all that often but I have seen doctors recommend a “comfort care because he’s dying” approach before it seemed really necessary. Alternatively, is it possible that you’ve interpreted their recommendations as meaning they think your father is dying, but in fact they might have some other idea in mind? Or perhaps the medical team is aware of other worrisome signs that indicate a poor prognosis, but this hasn’t been communicated to you?
I would recommend asking more questions of the team. Tell them you’d like to better understand what they think is going on with your father’s health and what to expect.
Another thing you can try would be to ask for a consultation with a palliative specialist. Many hospitals have them available. Please don’t assume this means you agree with a “comfort care” approach for your father; the purpose would be just to get more help discussing a difficult situation. Palliative care providers have more training than the average hospital doc in discussing difficult situations with families and clarifying what is going on. Good luck!
Hi, my mother is 68, and underwent surhery for early stages pancreatic cancer on 11 dec 2018.(7 weeks ago). All went ok, just some fluid issues kept her in the hospital. 3 Jan she was moved to the ICU with septic shock, week later a stomach bleeding, cardiac arrest. They got her stabile but one day shy of 4 weeks ICU she still has no contact with the outside world, she is awake but does not move or communicate. The doctors assume it is a hypoactive delirium but are not sure. She was an active person and suddenly not even recognition, have you seen a delirium lasting this long before ? thank you
So sorry to hear of your mother’s condition in the ICU. Delirium can indeed last a long time, especially if the person has been very seriously ill, which it sounds like she has been. That said, to be really immobile and uncommunicative sounds a bit unusual; usually with hypoactive delirium, the person is quiet and spaced out and inattentive, but would not appear to be asleep all the time or comatose.
I would recommend that you keep asking them to explain what they think might be going on. You could also ask if a specialty consultation could be considered, such as an inpatient neurology consultation. Good luck, I hope she gets better soon!
Hi Dr. Kernisan, I want to thank you for sharing this information about Delerium in the elderly. I am currently in the middle of a situation with my mother who is 76 (77 in April). On Thursday1/31, my dad sent me a message asking me if I could come over to the house and help him as my mother wasn’t feeling well. When I arrived my mother was throwing up and definitely miserable. She was able to give short yet delayed one word repsonses when we asked her about what she was feeling and whether she was ok with us taking her to urgent care. We got her to urgent care and the ruled out flu(by rapid swab) but told us we needed to go to the nearby hospital to rule out stroke. At this point she was growing agitated, was able to recite her name and dob (over and over) and was still doing one to two word delayed responses. We took her over to the hospital and she was diagnosed with a mild uti and they said there was an issue with her thyroid medication “working to well”. I believe she has hypothyroidism. Another issue to note is my mother had back surgery a month prior (12/27) and was still in some pain (in the days prior to us taking her to urgent care and the hospital) and she was taking both tramadol and Vicodin routinely at night. The week before her admission my mother was her usual self. She was driving herself places, went out to eat with the family,and played bridge with friends as recenly as four days before the urgent care visit in 1/31. They admitted my mother to the hospital on 1/31 and in the morning on 2/1 she did not know my name or my dad’s name. This has never been an issue for her. I was shocked. Since that time they have run multiple MRI’s, CT scans, blood and urine testing, and even a lumbar puncture. Her veins evidently disappear and they have had to change her Iv multiple times which has really upset her. Her hospital room has u fortunately been well trafficked by nurse and dr’s each day which she has complained about in her more lucid moments. Since 1/31 my mother has gone in and out of confusion and agitation. At times she has a blank look on her face and her eyes don’t track. She becomes non responsive and sort of stares into space. Then moments later she can snap out of it and her sense of humor comes through and she is oriented to time and place. This goes back and forthe through the day and is consistently happening when it gets dark. Her test results have ruled out stroke and meningitis and I imagine many other things. Her WBC count is now normal. She began A-fib while at hospital and developed wheezing and coughing. She is still a-fib and i saw it go as high as 130. The respiratory therapist says the wheezing is In Her throat area and not her lungs. She was hyperventilating yesterday and they finally moved her to the icu which is calmer and much less activity. They gave her a PIK line yesterday and gave her Ativan to do it. They also had to hold her arms down because she was so agitated. I’ve seen her unable to keep her arms still several times through the day, every day she has been at the hospital. I read your information about delirium last night and asked Mom’s ICU nurse about it. She had previously told me her mother had dementia and that mom’s symptoms were similar. When I asked her this morning about delirium she was quite dismissive. She said that if Mom was suffering from delirium she would be hallucinating all day long and basically be seeing purple unicorns all day long. She said delirium does not come and go. I thought her description perhaps better matched The DT’s people get when withdrawing from alcohol not necessarily the delirium you speak of. She also told me today Mom doesn’t really have any underlying medical conditions now as her WBC count is now normal and they have ruled out so many things. She said she thought in the next day or two the dr would recommend sending mom home and emphasized that home would be better than skilled nursing because she would benefit from being in her home that is familiar to her. From what you have written I am wondering if perhaps mom is suffering from delirium rather than dementia. I am willing to accept a dementia diagnosis if a neurologist dx’s Her as such but I am also concerned the hospital is over looking delirium and they could be actively helping mom and us in how to best address it. I didn’t get a chance to speak to her Dr about delirium this morning because i had to leave for work. My dad plans to discuss it with her Dr. Thoughts? Thank you so much for your time!
So sorry to hear of your mother’s illness, it must be so hard for you to see her this way.
If I understood correctly, the ICU nurse said “delirium does not come and go.” This is not true, the DSM-V criteria for delirium say that “the [mental] disturbance develops over a short period of time (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.”
What you are describing does sound like a very typical case of hospital delirium in an older adult. Now, some older adults do have pre-existing dementia and this can be “unmasked” by the delirium. Most neurodegenerative dementias, including Alzheimer’s, cause brain changes for 10-15 years before symptoms are obvious, so a big stressor on brain function can allow symptoms to seem to suddenly emerge. To determine whether actual underlying dementia is likely, we normally would have to talk to family and others, to determine whether there were signs of deteriorating memory or thinking prior to the person’s illness.
The main thing that health providers should do, if they suspect delirium, is to keep checking for triggers and aggravators. Otherwise, even when no triggers or aggravators are present, it can take days or longer for delirium to resolve. During this time, the person needs “supportive” care: rest, reassurance, exposure to daylight, mobilization, hydration, etc.
Hope she gets better soon. Good luck!
I just have a quick question. Is TV ok during the day for someone with Delirium. My father seems to slowly be coming around after a very long stretch in the hospital and significant delirium. He seems to be just a little better every day. But the one thing I notice, he just stares at the ceiling or stares straight ahead. Now…if I talk to him or get up and move around he will look at me (he can’t talk right now as he is on a ventilator with a tracheotomy), but he can shake his head and answer yes or no sometimes if he is more lucid. I want him to be stimulated during the day and I often play music, but is TV ok too, or is that too much stimulation? Thank you so much for this site and what you are doing.
Hm, that’s a good question. Well, it IS good to provide some stimulation, especially stimulation that is social, reassuring, and pleasant for the person. And you also want to avoid overstimulating or exhausting the person. What to do about TV probably depends on the person, whether they generally liked TV beforehand, what kind of TV programming is being displayed, and also on the specifics of where they and their brain are at now. There’s really no substitute for trying it and seeing how he responds. The company of a live person would be better but if that’s not possible, I’d think about trying some programming that is more likely to be restful, e.g. nature documentaries with minimal advertising breaks.
Re music, probably what’s most important is to play music your father likes. And always, try to keep observing how he responds so you can figure out what he seems to find restorative. Good luck!
So much of this applies to my dad, but I need some help. In January, my dad was able to use his walker to go to restroom, walk across the house, and even go out to the car with minimal assistance. He’s been a multiple myeloma patient for 12 years and is now 84. He went into hospital a month ago because of going into kidney failure due to lack of movement-likely caused by getting a cold and feeling bad-so he didn’t eat much. After a week in hospital, he was better and went to rehab. At that rehab he was eating well and seemed pretty alert, but they did not do much “rehab” there. We moved him after a week to a different rehab that he was in last year. He developed a cough, and they treated him for pneumonia preventatively. On weekly bloodwork it showed up that his hemoglobin was 7.0 so they transferred him to er for blood. There, they found he actually had pneumonia so they started IV antibiotics. They were giving him fluids and 2 units of blood because his hemoglobin had dropped to a 5. The day after the blood, he was back to how he was acting 2 months ago…very conversational, ate 3 meals for the first time in over a month, wanted his cell phone, things that had not happened in over a month. He was still good the day after that, though a little less alert-but still eating well for him. Then yesterday he ate some,but he was not as alert as two days before, but he was medically stable (hemoglobin 9.6 and creactin was 1.0) so they sent him back to the post acute rehab he was in- that is three days after his transfusion and one day after taking him off his fluid drip. This morning, he is so lethargic. He keeps saying how tired he is, and he barely ate. I am so discouraged! Obviously, the 2 units of blood and a few days of fluid got him on the right track, but how do we keep that up??? I really think he has hospital delirium having not been home in a month, and we SO want to bring him home, but we need him to get to where he can at least toilet again! In the hospital, they did a CT of the brain and abdomen, and there was no evidence of stroke and they only saw minimal stool in the bowel so they gave him some medicine. They supposedly did some more tests to see why his hemoglobin would fall from a 7 to a 5 in a day, but they have not found anything conclusively. I wanted to know if there is anything he can take, a vitamin, etc that would help him keep up the energy and congnitive level he had the day after the blood transfusion!? Any suggestions? I was so encouraged this weekend because he was feeling so good, so I know he is capable of feeling like that!!! Thank you for any suggestions.
Hm. From what you describe I’m not sure he is experiencing delirium. It sounds odd that his hemoglobin would drop from 7 (which is low) to 5 (really low), but that they wouldn’t have found the cause of this.
Honestly, he sounds like one of those medically challenging patients who stumps the doctors for a bit and needs extra evaluation before they figure out what’s going on. It’s really not possible to determine what he can take to maintain his energy and cognition without knowing more about what’s causing his symptoms and health problems in the first place. 2 units of blood and fluids is essentially the equivalent of a fancy bandaid on a wound; it does not tell you what caused the problem in the first place.
I hope that either by now they have figured out what was going on with him, or that he is better. Good luck!
I realize this is an older post, My Dad had a total knee replacement done on April 10, 2018 he was 78 years old. My Dad was very active drove to a city near by to visit friends every weekend. Did his finances, grocery shopping, yardwork etc. Surgery went well said they fixed his knee and then my nightmare began. The first day after surgery he was given pain meds every 5 to six hours and slept alot. The next day he was so groggy that my sister voiced her concerns… I however thought it was the meds and though when they taper off Dad will be back to his normal self… That did not happen he had confusion and bouts of pure meaness that was never a trait of his before. For instance he told a nurse that tried to give him meds are you as ugly on the inside as you are on the outside? Then he began refusing to take meds , talked of people from the past and it was so scary. There were times when he seemed ok and was better only to get back up to the hospital to have him swatting flies that wasnt there or having a shouting match with a caregiver. Again my dad went into surgery perfectly fine and came out almost childlike… he was in the hospital for a week and then We did therapy in the hospital for 14 days and then we were called in to have a meeting, not one doctor was there only therapist telling storys of how aweful my dad was. And ‘if ” a skilled nursing facility would take him we could go there. No nursing facility wanted to be bothered with his behavior, or they were full. we took him home and have 5 days of sleepless nights, got home health and therapy invovled and thought we were going to beat this deliurum thing when he got sick to his stomach and was dehydrated we had him brought to er and all his levels were out of wack… 5 days in hospital with dilerum my dads heart exploded almost one month to the date of this total knee replacement. I miss my father and have so much sympathy for anyone going through this. No one warns you about this before your elderly parent elects to have surgery of they did not us. Prayers to whoever has this same nightmare
Oh, that is quite a story and I’m sorry that it came to a sad ending. Yes, you are right, older adults and families are often advised to consider the risk of delirium and other complications that can occur after surgery. The good news is that more and more hospitals are creating programs to be proactive about preventing and treating delirium, so perhaps fewer families will be affected by delirium in the future. I’m sorry for your loss and take care.
My 76 year old father recently had a bowel obstruction removed, Feb. 23rd. In ICU he began complaining about the “honking” machines and all the people coming in an out the area. His agitation grew, and his determination to go home increased to the point of obsession. He began picking at his IV and bile tube. I came back from a daily mandatory 2 hour visitor leave and saw a lot of commotion from his room. Within the two hours I was gone, he had removed his IVs, his bile tube, and was working on his catheter. Everything was replaced, and they restrained him and gave him a sedative to force him to calm down. There was no reasoning with him, and he often would ask for a knife to cut thru his restraints, but then would at another point ask us to take his hands from his pockets as if not understanding he was restrained. He could answer questions about his childhood, military service, and was still as sharp memory wise as when he was admitted. But he did not understand why he was in the hospital, actually believing he had maybe been in a car accident. I spent one night physically wrestling with him to keep him in the bed so they would not restrain him and sedate him. They had told him he would be moving to the step down unit, which he interpreted as going home, and he had no intention on waiting. At this same time he would tell us what he was going to eat when he got home… pizza, ice cream, etc. This was a comfort to us actually because due to the bowel obstruction he did not have a good appetite prior to surgery,
When moved to the step down unit, things did improve. He started to clear mentally, but there was still some confusion. As I’m writing this now, he is still in the hospital. He communicates well, seems much more himself, but he has a complete refusal to eat. He is very weak, and when we plead with him to eat his response is he can’t or he makes excuses why the food is inedible. Being that physically he has recovered from the surgery itself, his doctor is discharging him, even with the fact that he’s extremely weak and on day three of not eating, and in my opinion, depressed. But, we were told that home health was set up for him, coming in home to rehabilitate him. I saw this as a positive, as I felt getting him out of the hospital setting would help the delirium to clear more, and maybe being home would spark his interest to start eating again. But now we are being told that the physical therapist requests he goes to a nearby rehab facility instead, so he’s going right back into a hospital setting, depressing and foreign and will more than likely need a feeding tube. I’ve read many articles about how these patients only seem to recover when they get away from the hospital, so this was not the news I was hoping for,
My main question is about the refusal of food. Could this still be a symptom of the delirium, and the fact that we can’t seem to reason with him about how his eating is dependent on him getting his strength back and going home?
Sorry to hear of your father’s situation, sounds like he has had a rough time with his illness and hospitalization.
He certainly could still be experiencing some delirium, but in that case, I would expect him to have some symptoms (e.g. confusion, inattentiveness, being spaced out) at times. Just refusing food and otherwise behaving normally sounds unusual for delirium.
You could try to see if they can get a nutrition consult. Or a speech therapist might be able to check his swallowing. Good luck, I hope he gets better soon!
Thank you for this article and the answers to previous asked questions. My mother-in-law has been in and out of the Hospital since the middle of December with UTIs, blood infections, and then she went through a time when she stopped eating which is her current state. She is currently with a feeding tube. He has had to be restrained due to wanting to remove the tube. She’s had many complications and has coded twice.I’m under the impression that they are trying to treat her delirium which wa the current issue until yesterday when they mentioned she may have some complications with her thyroid. She also is not able to pass a swallow test. I am not the point of contact so we (my husband and I) feel a bit in the dark. What we do know is she is agitated, seems to have lost her memory (names/events/doesn’t recognize us), makes some inappropriate comments to people, and continues to take off her hospital gown. (She is bedridden, but has asked to go to the bathroom and doctors tell her to go…due to catheter, she isn’t being offered the restroom.) Part of me questions delirium over dementia at this point, though she didn’t exhibit symptoms prior to December. What would be the difference? Thank you for your help and insight.
Sorry to hear of your mother-in-law’s condition, it sounds like she’s been sick for quite a while, which must be very difficult for her and for the whole family.
I cover the difference between delirium and dementia in this article: Delirium vs. Dementia.
Good luck and hope she gets better soon.
My significant other was recently hospitalized for liver problems that where result of his congestive heart failure which made his kidney problems worse and is now on dialysis. The doctors in the hospital told me that his state of confusion and memory loss was due to hospital delirium after they had corrected the ammonia levels from his kidneys that caused paddock encephalopathy. It has been over three weeks he is now in rehab and although he is better he is still very angry and sometimes confused combative end I don’t know what to do. He is 61 years old I don’t know if it could be dementia as well or it is delirium and will take time to resolve.
Sorry to hear of your partner’s situation. 61 is pretty young for the more common causes of dementia, although it does happen. It’s also possible that his mental function is being affected somewhat by his liver condition. In general, it’s best to give a person time to recover from delirium before assessing for possible dementia. This is especially true for people who weren’t manifesting any memory or thinking problems prior to hospitalization.
Good luck, I hope he gets better soon.
Hi, I’m really hoping you can help as we are feeling very ill informed by the hospital. My grandfather has had arthritis in his legs and hip for a while now and even though walked badly was still using sticks and driving and very independent, he was very sharp and knowledgeable and if you wanted to discuss something complex he was the best to go to as he was so brainy! He’s 85, and four weeks ago had a fall at home and fractured his hip, as soon as he was admitted into hospital I noticed a slight change in his mental status I brought it up to hospital staff multiple times, the hospital decided he would not be a good candidate for a hip opp as he has a weak heart and the break is one which can be healed without. He was sent home a week after and seemed a little confused and irritable which is completely against his nature and even though told to stay seated until the physios arrive he got up and fell again. He was re admitted and some days he seemed ok but others he was confused, the Friday he seemed nearly himself and home was prepared again for his return Monday. However when visiting him Sunday he was completely confused again (hallucinations, not being able to speak or listen) I kept pushing the gps and nurses until they finnaly tested and he proved positive for a UTI he has had a week intravenous antibiot which finished last week but he has just continued to decline, now we walk into his hostpial ward and he doesn’t stir when he does now and again open his eyes he just babbles and the most distressing is his body keeps twitching and he keeps jolting his arms and legs and going stiff as if he’s in a lot of pain (he says he’s not when pushed to tell) on Friday a doctor told us to prepare for the worst which devastated us as he was only admitted with a fracture and was due to come home just last week , we went in yesterday and couldn’t stop crying as we thought this was it he seemed to be in a deep sleep hallucinating and unable to wake however a few minutes later a specialist doctor came in and told us his overall health has been improving and no problems with his brain scan and his heart has been working better as his fluid retention has gone and his blood pressure is good, but he has got delirium, they have said they have been monitoring him and it is just a case now of a waiting game, I don’t no who to believe anymore as we are constantly told conflicting information, he is eating and drinking well now. I have read all the posts and responses here and have not noticed anything about the body tensing and arms and legs randomly lashing around and the not being able to speak (just making noises instead) the specialist doctor said that is becouse of the delirium , would you think this to be true? Very sorry for this long comment we are a small family and struggling very badly, this is the hardest time of my life so far, many thanks Christina
Sorry to hear of your grandfather’s fall and subsequent health issues. I think what you are describing does sound like delirium. It can be due to the stress of hospitalization but also it is easy to develop additional illness and complications in the hospital. (Plus you mentioned he has a weak heart.)
For someone like him, you can keep asking the doctors whether they think there is any particular medical condition currently causing his delirium. If not, then it’s just a matter of time and rest and he will probably improve with time. It can take a while though, and that is certainly hard for everyone involved. Try to remain hopeful and be with him, that is usually of great comfort to older adults during the stress of hospitalization. good luck!
My 90-year-old father had a toe amputated in April 2018. Within 24 hours he became delirious, trying to get out of bed, insisting he was on a ship and needed to go to the galley, thinking the wall facing the foot of his bed was a floor and that the TV was a window to the ocean, actually a porthole. This and much more went on for ten days in the hospital. I stayed every hour with him the entire stay. It was exhausting. Medicare tried to discharge him, but I gained two days grace. I thought the Vancomycin was the culprit and at my request, the doctor switched to another drug, although he said the Vanco was not causing the delirium. When he finally went home he began to come around, but now a year later he still has confusion about things such as whose house he is in. He has been loosely diagnosed with Lewy Body dementia and has been taking Lexapro for about 8 weeks now. Unfortunately, he is scheduled for another toe amputation in two days, same foot. I am scared of the delirium recurring and I have read that the odds are high that it will. To prevent it, I told the doctor I want to take him home as soon as possible after the surgery, like even within 12 hours, and have a daily visiting nurse, but he said the risks of bleeding, etc. are greater than the chances that he won’t develop the delirium at home anyway. Is that true? I thought just getting him home would prevent the confusion. Last year I was afraid to take him home and away from the medical support he was receiving at the hospital, but now I’m not so sure. Is it better to go home as soon as he can, or stay in for the medical care and IV medicines, etc.? The delirium was definitely easier to manage at the hospital than at home, but I felt like the unfamiliar surroundings were adding to the confusion. By the way, he is not diabetic. He has peripheral artery disease and osteomyelitis in his right foot.
Glad you are being proactive and thinking about how to minimize your father’s delirium risk. It’s true he’s at risk of it happening again, based on his past history of delirium and also because he has dementia, which makes it easier for people to become delirious.
Being in a familiar environment can help but is no guarantee of avoiding delirium. I think with either option, you will be facing some risks and challenges. Probably there is no exact right answer, so pick one approach (do consider your ability to manage his post-operative care and wound if he goes home) and then hope for the best. Good luck!
Hi,
My 69yr old father who has Parkinson’s disease (12yrs) went into hospital on the 2nd April for a hip replacement. About 2 days after surgery he developed early signs of delirium. Day 9 He was then transferred to a nursing home to start rehab for his hip, his delirium had increased terribly by this stage. The nursing staff took him off all of his Parkinson’s medications saying they could be interfering with the delirium. They started him on a antipsychotic medication as well as strong pain killers but My question is, is it safe to just completely stop Parkinson’s medication without weaning?
Then whilst still in the nursing home, my father had a fall. He shattered his femur in the same leg he had the hip replacement and has since had surgery again to fix the break and is still in hospital now. His delirium is worse than ever and nothing seems to be helping him recover from it. They have put him back on all his Parkinson’s medications, but I can’t help but think that all this change would be totally messing up his head.
We really want to get him home to familiar territory and hope this will help with recovery.
This is so upsetting seeing him like this…
Oh, this sounds awful for your father and also for your family, that’s really unfortunate that he fell in the nursing home.
I don’t usually manage parkinson’s medications (most patients have a neurologist overseeing that aspect of their care), but in general, my understanding is that suddenly stopping Parkinson’s medications should be avoided. That said, certain Parkinson’s medications can also make people prone to hallucinations, so I can see why it could be a challenge to manage Parkinson’s medications in the face of significant delirium.
I do know that it can take weeks or longer for vulnerable older adults to improve from their delirium. I hope he’s started to recover and that he gets better soon. Good luck!
My 64 year old active healthy dad had an accident apr 20. Had heart surgery that night. On a ventilator morphine numerous antibiotics and sedated for 2.5 weeks. Developed pneumonia and infection in lungs. Woke up not great mentally. Moved from icu to general ward early last week and mentally deteriorated. Lungs crashed due to infection last week and was reintubated and back on ventilator for 2 to 3 days in icu. When ventilator was removed last thurs I had a regular conversation where he got all details right names places etc. since then he’s deteriorated again, paranoid that someone is trying to hurt him / steal from him etc. Hes recovering from his physical injuries but mentally deteriorating. Do you think we just need to give it more time? Most articles seem to mention up to 2 weeks but we’re way beyond that at this point….
Sorry to hear of your father’s accident. I have often seen it take several weeks or many months for an older person to recover from delirium. Most of those older people are older and less fit than your father, but he did just spend quite a while in the intensive care unit and he’s had infections, so I’m sure he’s been physically quite weakened. He may just need more time to slowly recover.
A small minority of people your father’s age never do completely recover to the way they were before. But I think there’s not much use in worrying about that at this point…better to focus on supporting him as he works on recovering from the accident and hospitalization. Give him and yourselves time and then see where you are at. Good luck!
Hi there, after reading your article it has really made me question if my grandfather is suffering from this. He has been in and out of the hospital since December 18th 2018 and has now been hospitalized since about April! From April until now he has significantly decreased in health and his cognitive skills. He often forgets things he says or completely forgets entire conversations. The nurses have said he may be “sundowning” which could just be what’s happening. Unfortunately he is under a huge amount of stress as his house is being redone without him there and he has really lost his independence which is really upsetting him. He seems to have given up, he’s refusing to get in the wheelchair and go for walks or even eat his dinner! Could this be delirium?
So sorry to hear about your grandfather. Especially with such a long time in the hospital, it wouldn’t be surprising for him to experience some delirium.
We do see some older people seem to “give up” after weeks in the hospital. Sometimes we’re able to identify a specific medical cause, but often I think it’s partly that they are just so worn out by the stress of illness and the hospital. I do sometimes see people recover after a long hospitalization like this, but it can take months and usually requires a lot of tender loving care at home (and also, no longer having whatever serious illness landed them in the hospital).
I hope he starts to improve soon. Getting him to familiar restorative surroundings might help. Good luck!
Prior to Mar.31,2019 my 89 year old mom was adapting nicely to her independent senior living apt., that she moved into the prior Oct. (after living 29 years in her own home in FL, she had fallen several times in FL , becoming depressed , didn’t want to live with us, but wanted to be closer). She made new friends, participated in lots of activities. She loved having no more yard work, prepared meals and housecleaning taken care of. End of March she fell, taken to ER, no concussion, but sent to hospital with severe sepsis. It took 5 days for the infection to respond to antibiotics, during which she developed and was diagnosed with delerium. They took her off all her regular meds, including Prozac and she ate, nor drank almost nothing . Her speech changed, she became agitated. They put her on halidol and risperidone, she went psychotic. She was ripping her clothes off, screaming, trying to get out of the hospital bed. The doctor ordered a saline to get it out of her system. It took 5 more days for her to become semi lucid. She was discharged to rehab for physical therapy, as she could not longer walk. At rehab she made physical gains, but still had lingering delerium and agitation. After 20 days she went back to her apt, with in home physical therapy, which she often refused. May 23 she fell again, back to ER, no concussion, but goes back to rehab facility. This time she has her skin torn day 1 by CNA trying to help her from chair (she now cannot transfer from chair, bed or walker, not even for toileting). This triggered daily morning crying spells, moaning when moved anywhere, less cooperation with therapy. I was there Sun., watching her ride an exercise bike, talking about moving even closer to us, but still having more aphasia speech. Monday morning she went into another psychotic event, I came and saw her trying to rip off her clothes, screaming, delirious , wild eyed, totally incoherent speech. We though she had a stroke or seizure and back she goes to the hospital. Now 8 days later, (after once again being taken off her reg. meds, put on Valium, Ativan and keeps)…she has eaten or drank little, sleeps most of the time, speech is almost intel liber. What we can understand is that she wants to die. She is totally immobile. We , are dia led and cannot care safely for her at our home and she cannot go back to her apt. As they cannot meet her needs. I hate to move her to assisted living, but there is one within minutes from us. She will have her own furniture there and inhouse therapy. Hopefully counseling. I am her only child. This is heartbreaking to seen her this way. How else can we help her?
So sorry to hear of these events. Your poor mother, she has been through a lot. Unfortunately, a serious illness can set off this type of negative spiral. People do sometimes pull out of it, but it’s hard for them; the longer they are ill or delirious or weak, the more time and effort it takes to climb out of it. Some do seem to give up or lose their will to try to recover. It can be hard to tell if this is purely mental or if it reflects some kind of more substantial change going on inside the body. It may well be some of both, since the mind and body are closely connected and influence each other a lot.
In terms of what you can do next: she is certainly going to need a higher level of care for some time, possibly indefinitely. One thing you could inquire about would be a palliative care consultation, to talk about the big picture of her health and also to get advice on how to improve her quality of life and treat distressing symptoms. A related possibility would be to see if she might be eligible for hospice. I have actually seen a certain number of frail older adults RECOVER while on hospice and eventually “graduate” from hospice, because hospice provides lots of TLC and attention to uncomfortable symptoms, and that can help an older person recover! Hospice is also a way to get a nurse and other services to see an older person where they are living, which can be hugely helpful. Last but not least, hospice is designed to provide emotional support to the patient and also to the family.
Good luck, I hope she feels better soon and that you find the support she needs and you need.
My 91-year-old father just had knee-replacement surgery. Starting the second day after surgery, he is showing significant post-op delirium. He’s combative and hallucinating, just to name a couple of symptoms. He needs 24/7 monitoring to ensure he doesn’t hurt himself. And given his knee, he’s confined to his bed because he’s to weak and it’s too painful for him to stand.
The hospital keeps telling me this is very common and that it will resolve on its own in a few days or a week. From what I’m reading on here, that doesn’t seem to be the case. Plus, their treatment plan is simply to eliminate pain killers aside from Tylenol and to let the anesthesia dissipate. Surely there is more I can do for him to speed his recovery.
Note that he just moved from MN to TX so there are no “home” familiar surroundings to go back to. Plus, given his knee, he will need to go to a skilled nursing facility instead of any type of home environment.
So two questions.
What can I do to speed recovery?
What can I do for myself in this incredibly stressful time. I’m an only child, and I have no family or friends to support me. Getting through the day is incredibly difficult, and I’m not sure I can handle this if it goes on much longer.
Sorry to hear of your father’s delirium. Delirium does improve within several days for many older adults, but yes, it can also take much longer than that, especially in people who are your father’s age.
In the article, I list things that can be done to try to bring about recovery. In terms of what you can do for yourself, I would encourage you to find a support group if at all possible. Online groups are often convenient. A very active free online caregiver community is at AgingCare.com; if you post there, you will get lots of ideas and support. We also offer our own Helping Older Parents Membership Community, which combines a support group with guidance from me, geriatric care managers, and other experts.
You need to try to help but also realize that you’ll try your best and you may not get the outcomes you want for him, because much of this is out of your control. So try to not feel guilty or let the worry take over your life. Support him as best you can and hope for the best. Do connect with other family caregivers, almost everyone finds it enormously helpful. Good luck!
Thanks for this wonderful forum. My Mom is 90 years old and has no dementia other than some sometimes short term memory loss (she is regularly tested and evaluated). However, she has experienced delirium several times that I know of. Twice from meds, which I promptly removed and she immediately returned to normal. Then, when she was about 85 years old, we worked through a bad delirium experience over a period of two years–the result of a broken pelvis and too long on oxycodon. Again we beat the odds. About a year ago, she had a sudden onset from fecal extraction, and she rebounded very quickly. Now we’re at it again, and I am reading everything I can find to make sure I am doing the right thing and to seek additional recommendations. Mom now lives with me. On a Thursday about three weeks ago, she suddenly and out of the blue showed some signs of delirium: thinking a strange man was trying to call her and thinking she was supposed to cook dinner. That same night she fell and broke two ribs and her thumb which landed us in the hospital. She almost immediately developed hyper delirium in spite of all my attempts to prevent it and warn docs of her propensity for it. She was tested for everything–no UTI (evaluated twice at my assistance); BP good, heart good; all bloodwork great; etc. With the exception of Ibuprofen she has had no new drug introductions–she takes no meds other than the few she has been on over the past two years. We tried rehab but I knew we weren’t gonna get through that, so after a few days I brought her home (wish I’d never taken her to the rehab center where the delirium got worse). Between me and others, she has 24/7 care. It’s now been three weeks since the Fall. There are good days and bad days, but the home environment, sunshine, PT, OT, daily slow walks, good food, and constant care seem to be very slowly easing us out of the delirium. BUT she is just not sleeping well at all, and I am left with thinking sleep deprivation is the culprit. Or have I missed something? What would have caused this sudden onset BEFORE she even fell? She was just fine, and then she wasn’t. We are keeping a sleep diary. She tosses and turns, and jerks herself awake. I have tried everything (essential oils, herbal teas, etc) except meds, and I am just not inclined to go there. I have already had her on Melatonin for over a year. I have just ordered an herbal tablet to try. Shorter question: My Mom was fine on Wednesday three weeks ago, developed delirium out of the blue on Thursday, and I have no idea why. Nor can I look for ways to prevent it when I don’t know what “it” is. Could it be the sleep problem? Was it lack of sleep that caused her to fall in the first place? Other ideas?
Sorry to hear of your mother’s difficulties. It’s wonderful that you’ve been able to support her through so much.
Well, it sounds like on that Thursday, she had a period of confusion or disconnection from reality. If we thought it was due to a new physical illness or medication, we could call it delirium. But if she’s 90 with short term memory problems, it’s also possible that this was just a manifestation of her vulnerable and somewhat damaged brain having a worse moment. (her short term memory problems indicate that her brain has been damaged enough to be symptomatic.) Her fall may or may not have been related.
At this point, I don’t know that it’s productive to keep trying to figure out what was the Thursday trigger. Many problems in people like your mother are “multifactorial”; they result from a combination of lots of underlying vulnerabilities plus one or more little triggers.
I would recommend focusing on where you are at now, which is supporting her and trying to see if you can improve her sleep. Sleep certainly can be disrupted by brain changes. For ideas on how to improve sleep in people with memory and thinking problems, try this article: How to Manage Sleep Problems in Dementia. Good luck!