“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.
Sher says
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!
Leslie Kernisan, MD MPH says
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.
E Pierce says
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?
Leslie Kernisan, MD MPH says
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!
Amanda says
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?
Leslie Kernisan, MD MPH says
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.
Rose Hammond says
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
Leslie Kernisan, MD MPH says
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!
Chris says
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
Leslie Kernisan, MD MPH says
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!
Grainne says
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.
Leslie Kernisan, MD MPH says
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!
Valerie says
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.
Leslie Kernisan, MD MPH says
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!
Donna Stols says
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.
Leslie Kernisan, MD MPH says
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!
Teri Sweeney says
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.
Leslie Kernisan, MD MPH says
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.
Christine Gareis says
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.
Leslie Kernisan, MD MPH says
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!
kathlyn talbot says
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 ?
Leslie Kernisan, MD MPH says
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!
Donna says
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.
Leslie Kernisan, MD MPH says
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!