“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.
Karen Bryant says
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.
Leslie Kernisan, MD MPH says
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.
Marie Devlin says
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
Leslie Kernisan, MD MPH says
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!
Marie Devlin says
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.
Leslie Kernisan, MD MPH says
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.
Carol says
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.
Leslie Kernisan, MD MPH says
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.
Isabelle Noble says
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
Leslie Kernisan, MD MPH says
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!
Sean says
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.
Leslie Kernisan, MD MPH says
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.
Mark Lyon says
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!
Leslie Kernisan, MD MPH says
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.
Melissa H. says
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
Leslie Kernisan, MD MPH says
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!
Leslie Kernisan, MD MPH says
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”
Tmalpass says
Great news about you moms recovery. Gives much hope! Great news! Thank you for sharing!
Sharon says
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
Leslie Kernisan, MD MPH says
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.
Kim Dean says
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!
Leslie Kernisan, MD MPH says
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!
Kim Dean says
Thanks so much for getting back to me!! He is improving slowly!!
Leslie Kernisan, MD MPH says
That’s wonderful!
Chris Hamilton says
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?
Leslie Kernisan, MD MPH says
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!
Lisa says
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
Leslie Kernisan, MD MPH says
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!
Danny says
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
Leslie Kernisan, MD MPH says
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!
Jac says
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
Leslie Kernisan, MD MPH says
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.