“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.
It is sometimes referred to as “hospital confusion” or “hospital sundowning.” And if it happens in the intensive care unit (ICU), it is sometimes referred to as “ICU psychosis.”
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.
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.
Common causes of hospital delirium
Here are some common causes and triggers of hospital delirium and of “sundowning” symptoms when an older person is in the hospital. (Remember: in most older adults, multiple underlying causes and triggers are present.)
- Blood electrolyte imbalances (e.g. blood sodium being too high or too low)
- Infections, such as pneumonia, sepsis (bacteria in the bloodstream), and urinary tract infections
- General anesthesia and/or surgery
- Dehydration
- Drug toxicities and medication side-effects
- Withdrawal from alcohol, sedatives, or other drugs
- Blood glucose being too high or too low
- Sleep deprivation
- Kidney or liver problems
- Untreated pain or constipation
In people who have Alzheimer’s or another form of dementia, just the stress and unfamiliarity of the hospital setting can be enough to tip them into increased confusion.
Sensory impairments, such as uncorrected vision or hearing, can also help tip a vulnerable older person into 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 last reviewed in October 2025.
T.Jones says
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.
Leslie Kernisan, MD MPH says
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.
T.Jones says
Thank you. This information was very helpful!
Sandra A says
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.
Leslie Kernisan, MD MPH says
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.
Andrew says
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?
Leslie Kernisan, MD MPH says
Hm, now that you mention it, I agree that people with delirium do often fidget with their hands. Interesting observation.
Andrea says
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.
Leslie Kernisan, MD MPH says
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!
Shane says
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.
Leslie Kernisan, MD MPH says
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.
Judy Olmsted says
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
Leslie Kernisan, MD MPH says
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!
RJ says
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.
Leslie Kernisan, MD MPH says
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!
RJ says
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.
Marie Devlin says
What is an ACE unit?
Leslie Kernisan, MD MPH says
“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.
Ange says
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?
Leslie Kernisan, MD MPH says
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.
Nancy says
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.
Anne says
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.
Leslie Kernisan, MD MPH says
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!
Marie connolly says
Has anyone remember what they did and how there husband was with you when you were going through with delirium
W. Prins says
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.
Leslie Kernisan, MD MPH says
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.
Jan says
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.
Leslie Kernisan, MD MPH says
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!
Ravi Lescher says
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!
Leslie Kernisan, MD MPH says
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.
Nina Hicks says
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!
Leslie Kernisan, MD MPH says
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.
Karen A Ambrosia says
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.
Leslie Kernisan, MD MPH says
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!
Kevin says
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
Leslie Kernisan, MD MPH says
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.