Pop quiz: What senior health problem is extremely common, has serious implications for an older person’s health and wellbeing, and can often – but not always – be prevented?
It’s delirium, which affects about 30% of seniors during hospitalization. (Rates are much higher if there’s been a surgery or if the person is in the intensive care unit.)
People sometimes refer to delirium as “post-operative confusion,” or “ICU psychosis” or even “hospital dementia.”
Delirium is extremely important for family caregivers to learn about, because families are often the first to notice that senior isn’t himself or herself.
So I’ve written a comprehensive article for A Place for Mom, covering the definition of delirium and all the essential things you should know. You can find it here:
In this article, I explain:
- What is delirium, including symptoms and causes,
- How delirium differs from dementia,
- Why delirium is such an important problem to prevent and detect in seniors.
I also cover ten important things to know — and do! — about delirium:
- The statistics on how common delirium is in seniors,
- That seniors with delirium often become quieter (this is called hypoactive delirium), which is harder to detect but just as dangerous,
- That delirium is often missed by hospital staff,
- That delirium can be the only outward sign of a potentially life-threatening medical problem,
- That delirium often has multiple underlying causes,
- How delirium is diagnosed,
- How delirium is treated,
- That it often takes seniors a long time to fully recover from delirium,
- That delirium is associated with accelerated cognitive decline, and with developing dementia,
- How to prevent delirium.
To get the details on these ten things to know and do, read the full article here.
And then visit one of my favorite family sites for delirium, which is the Hospital Elder Life Program website.
Useful Online Resources Related to Delirium
Here are links to some of the resources I reference in the article:
- A study (one of many) finding that delirium is linked to worse health outcomes in the elderly
- A study of seniors in the Intensive Care Unit, finding that 43.5% had hypoactive delirium
- An article finding that seniors do better when they are hospitalized in an “Acute Care for Elders” unit (a special hospital ward tailored towards protecting seniors from hospital complications; they are great!)
- An explanation of the Confusion Assessment Method, which experts recommend doctors use to diagnose delirium
- A description of the Family-CAM, which experts developed to help family caregivers detect delirium
- A study finding that delirium accelerates cognitive decline in Alzheimer’s; a follow-up study finding that people with dementia decline twice as quickly after having delirium (!) is here.
- Tips on how family caregivers can prevent delirium, from the Hospital Elder Life Program
Last but not least, for my previous posts on delirium:
- Delirium: How Caregivers Can Protect Alzheimer’s Patients
- Hospital Delirium: What to Know and Do
- How to Maintain Brain Health: the IOM Report on Cognitive Aging
If you have any additional questions regarding delirium, please post them below!
Have you any help for families taking home their loved one who has delirium? I am living the experience with my sister’s and brothers and it would appear that there is no help from the mental health! Just keep getting told to seek social care but it’s only happening at night from 12:30 to 4:30am.
Usually our advice to families is to continue with supportive care: a reassuring, restorative home environment, minimizing overstimulation, etc. It’s usually best to not argue with anything irrational or odd that is said, and instead try to soothe the person.
If the confusion seems to be getting worse, then you should bring it up with the doctor. Sometimes an older person’s underlying illness relapses, or a new problem arises that might provoke delirium.
Has your sibling recently been ill and diagnosed with delirium? Was there pre-existing Alzheimer’s or another dementia? Symptoms just during the night would make me wonder about an older person developing some day-night confusion, or perhaps even some sundowning.
You might get some ideas on how to manage nighttime confusion or sleep difficulties in one of these articles:
5 Top Causes of Sleep Problems in Seniors
How to Manage Sleep Problems in Dementia
Definitely talk to your sibling’s doctor about this problem!
Thank you for the very informative articles. Great food for thought!
Glad you found this helpful!
Thank you so much for posting this article. My father is currently in the hospital, and is suffering from hospital induced dementia. My family is heartbroken to see this rapid decline in his mental state and the hospital staff who just wants to pump him up with medication to make his sleep. They even raised his bed and then tilted it downward so his head was below his feet. We asked the nurses why this was done and they advised us this is common practice to keep the patient from trying to get out of bed.
This article is so timely and comforts me and my sisters as we now have a little more knowledge about this condition.
Glad to be helpful. So sorry that your father has been experiencing this problem!
You may want to ask more questions about what medications he is being given to “make him sleep.” Hospitals sometimes administer sedating antihistamines or benzodiazepine sedatives for this purpose. But in geriatrics, we generally try to avoid using these, as they can make confusion and delirium worse.
Good luck, I hope your father starts feeling better soon. Most people do eventually get better, but it can take time, and it’s a stressful experience for everyone while the delirium is bad.
Hi, Thank you for your article. My father is 73 had spine surgery in August, went to a rehab facility after where he got a UTI which landed him in the hospital, he was in the hospital for a week and had acute delirium. Ultimately went back to the rehabilitation facility where things begin to clear up, and got better once he got home. He was at home for about a month, and got another UTI which landed him back in the hospital. At the hospital he had a very bad reaction to medication they gave him which landed him in the ICU. He has since again to have the delirium again. But worse this time as it’s been a longer Hospital stay. They would like to transfer him to a Skilled Nursing Facility, but we’re wondering if the delirium will clear in that type of setting or not? Thank you.
So, in principle delirium can clear in any type of setting. What affects delirium clearing is:
– Did the provoking illness or problem get treated?
– Are aggravating factors (which we can call delirium contributors) being minimized? Common delirium aggravators include poorly treated pain, constipation, dehydration, not having hearing aids or glasses, not getting out of bed enough, and so forth.
– Is the person able to get enough rest and recuperation?
– How resilient was the person’s brain before developing delirium? How physically resilient is the person?
Your father has unfortunately had three hospitalizations in the past few months, and was sick enough to be in the ICU this last time. This means he’s pretty physically and mentally depleted. People like him can recover, but the more depleted and weakened a person is, the longer it can take to recover, and the more vulnerable the person is to tipping back into delirium again.
The trouble with a skilled nursing facility (SNF) is that many older adults do not find them very restorative. Depending on how they are run and staffed, the situation may even aggravate a person’s mental state. It’s also possible for an older person in a SNF to develop a new complication or infection.
Many SNFs are not ideal for people who have been delirious. In terms of recovering from delirium, it’s probably better for an older person to go home and get skilled rehab services from home health. But that’s only possible if a person is medically stable enough, and if family members are able to provide a lot of support and assistance, especially in the first days home. So, you may have to go with the SNF. Do try to stay as involved as possible, as that can help with recovery.
I hope he starts to get better soon. Good luck!
Thank You! These articles have all been very helpful
Glad you are finding them helpful!
Our 82 year old Mum has been in ICU / HDU for about 10 weeks – and is “confused” but only sometimes. She’s a sharp lady normally, and sometimes she’s still like that – still has her sense of humour etc. You have a perfectly normal conversation and then, out of nowhere she asks why her mother (died 30 years ago) hasn’t been in to see her or where her husband (died 4 years ago is) – What to say? My sister, has had training for dealing with dementia patients, said she was told it is best to not upset her so she just fluffs the answers and says “Oh, they came whilst you were asleep” whilst a nurse on HDU told me to “keep her in reality” – just tell her “They passed away 30 years ago and you know this.”
Which is the correct approach? (Our hearts are breaking here!)
Before hospital, she was starting to get very forgetful but that’s all. She’s had a nasty UTI and has been on mega anti-biotic runs.
Will she recover? Chances? Anything else we can do to help?
I’m sorry to hear about your mom’s situation, I can imagine how hard it must be to see her still confused at times.
I would agree with your sister: the general dictum when it comes to dementia and delirium is that you should not insist on getting someone grounded in reality, it’s much more important to help them feel reassured and to avoid stressing them.
Now, in hospitals we do sometimes encourage staff and family to help keep the patient “oriented” to what is going on, with gentle reminders about where they are, what’s been happening. This might be part of what the nurse is referring to.
I usually recommend that people pay attention to the effect of their words. It can take a little trial and error to find out what the most reassuring and constructive approach is.
In terms of whether she’ll recover: many older people do recover once their health conditions stabilizes and they get out of the hospital. It can take a long time (weeks or often even months), especially if they were delirious for a long time, or if they had some cognitive impairment prior to becoming delirious.
If you haven’t yet read them, I would recommend going through the comments on the Hospital Delirium article, as they are relevant to your situation and might give you some hopeful ideas. Good luck!
My 60 year old husband had major surgery a week ago, and now is having profound hallucinations. Initially the doctors thought it was the narcotic pain medication, however, he has not taken any all day, and his hallucinations are getting worse. I’m likely going to return to the hospital, as this is scary for all of us.
Sorry to hear of this. Yes, if his symptoms are getting worse, then it’s definitely a good idea to alert his doctors and get more help assessing what might be causing or worsening any delirium symptoms. good luck!
My 85 year old father, who we recently moved into a highly rated and very nice assisted living facility, has been battling congestive heart failure (after a serious heart attack 5 years ago) along with kidney failure stemming from the chf. His short-term memory has been slowly declining.
Yesterday, my brother called him, and for about 10 minutes, our usually subdued father chatted on and on about currently being on a ship out at sea that had been hijacked by pirates. After they ended the call and my brother called to tell me about it, I called my dad.
He greeted me enthusiastically, immediately letting me know that he was “on a ship out at sea that had been taken over by pirates”, but he “got lucky and saved the day when the head pirate turned his back” on him, so Dad was able to hit the pirate over the head.
He told me he was in the Pacific when I asked him which sea he was in. He provided details such as he had a gun, but so did the pirates, and during our surreal conversation, Dad shot at them. He couldn’t remember how he ended up on this hijacked ship, but remembered he’d been on board since that morning. He remarked that the pirates, who were now captaining the ship “had no idea what they were doing;” that he had been “extremely lucky,” and agreed with me that this was an amazing adventure!
Although he had a lot of laughter in his voice while describing this current event, he said it wasn’t that much fun. Before he ended the call, I told him to please be careful. Being serious, he promised that he would be very careful.
His cognitive decline over the past several months has been at the worst forgetting what he ate for dinner, or if my brother had visited him earlier that day.
Typically, our telephone conversations lately have been brief and very basic. He hasn’t been very talkative at all, with either my brother or me.
That’s another reason why the pirate conversation was so weird: besides the content, he was energetic, laughing, animated, happy to answer questions, and instead of the usual 3 minute mostly one-sided conversation, these two calls lasted 20 minutes with him doing most of the talking.
What was this? My brother left a message for the nurse but hasn’t heard anything back yet.
Hm, interesting story.
Hard to say just what caused this, or how worried you should be. Usually, a sudden change in thinking or mental abilities is for the worse; this one sounds like an odd combination of “better” in that your father had more energy and animation and verbal output, but potentially “worse” in that he is telling an odd uncharacteristic story, which might reflect more confusion than usual.
One does hear about people with dementia having a random “perked up” moment every now and then like this…the brain and body are mysterious, we don’t understand everything that happens.
I hope he at least continues to be in good spirits. If you are worried about possible delirium, you could ask to have him further evaluated, or at least monitored a little more closely for the next few days. good luck!
My 85 year old father developed an infected toe. After many visits to various doctors, it was determined his leg had poor circulation and his foot had very little blood flow (no pulse).
During the procedure to insert a stent at the hip, the sedative Versed caused my father to become very combative, a side effect seen previously. We have no idea why Versed was used again. The procedure could not be completed.
For a few days he was somewhat confused but okay, and then he fell getting up from the couch.
After that he was very combative, restless, and stopped sleeping nearly completely. He spent a week in the hospital getting somewhat stabilized and then was sent to my sister’s, along with our mom. he was there for two weeks, displaying sundowners with worse and better days. Again no sleeping. After appearing to be improving, he had to return to the hospital after becoming very combative and agitated. At the hospital he broke his shoulder jumping out of bed, while his toes began to die.
The psych ward dosed him into nearly total unconsciousness and at that point he had a successful vascular bypass, then the toes were removed. A bout of sepsis followed but it responded to antibiotics.
He has never really awaken since he was drugged unconscious. The foot is healing but now he doesn’t even swallow and needs his mouth suctioned. All medications are being stopped, aside from antibiotics and minor pain medication.
Prior to this, my father could mow the grass, did his income taxes for 2018, and did the shopping for himself and mom.
Could this have started from from Versed? It’s been about 2 months since it began, and though he had some totally normal moments, he has been mumbling and mostly sleeping the last week.
No one at the hospital seems to know whats wrong with him. Brain shows no damage but his circulatory system is calcified heavily.
The only hope now is that after the leg fully heals, he will return to normal.
I share this mainly to warn others that Versed is not the best sedative for elderly patients.
Thank you.
Sorry for delayed response and thank you for sharing your story.
Versed is a benzodiazepine used for sedation during procedures. All benzodiazepines are considered risky in older adults and can cause confusion or even paradoxical agitation in some older adults. In other older adults, they cause sedation and decrease agitation.
I don’t know whether I’d attribute his mental decline entirely to Versed. Probably his brain was vulnerable to begin with, and then the combination of infection, hospital/surgery stress, and sedatives tipped him into delirium and further cognitive decline.
I hope he improves once his leg heals. Good luck and take care!
My husband recently was hospitalized for high blood pressure. They ran all kinds of tests and he is healthy. However, he seemed to all of a sudden be confused. He doesn’t know who I am. He recognizes pretty much everyone but he is not certain who I am.
He is 76 years old, never been sick and this is his first time in the hospital. We have been married 53 years. What could this be?
Sorry to hear of this problem, it must be distressing to suddenly not be recognized by a long-time spouse.
Such sudden confusion could be delirium, but it’s also possible that it could be something else affecting his brain. I would recommend asking his doctors for more information and help evaluating him. You might also want to consider a consultation with neurology. good luck!
This has been one of the most informative websites I have found. Thankyou! My 86 year old mum has been in hospital for 2 weeks. She was diangnose with pneumonia, sepsis, aspiration and then gall bladder infection. Treatment with
Antibiotics have worked however we now think she may have had a stroke. Right hand side of face had dropped and her speech very slurred. Doctors said she had delirium and up until the potential stroke she was communicative although talking strangely.. dogs in the ward,nurses trying to kill all the patients. Now she is sleeping all during the day and not very responsive. She now has fluid on her lungs which they have given her diuretics and ‘re catheterised her which is working. They have also given her anti vitals in case she has a viral infection in brain. We are waiting on her to get MRI as CT scan showed nothing. Echo showed heart ok. They are struggling to get her O2 levels right and said she arrived in Hopsital in AF and with level 2 Resp Depression. She is not eating. I live 8h drive away but my sister lives local to hospital. She is not in good health either. Doctors say different things each day and I am not sure if outlook is positive or negative and they won’t commit other than she is seriously ill but they are being hopeful. The longer delirium goes on worse the prognosis. I am.considering asking to work from home so I can stay at my sisters and share hospital visits or taking unpaid leave to be in hospital. But reading the comments it is difficult to predict how long this may be for. Any advice would be appreciated. Apologies for long ramble. By the way I am in UK
Glad you have found the site helpful but sorry to hear of your mother’s difficult situation! If her face was drooping and her speech became slurred, a stroke or TIA is certainly a possibility, and it does sound like she’s otherwise been delirious and very sick. Poor thing.
In terms of recovering: the longer the person is sick in the hospital, the longer it tends to take to recover strength and function. Also it takes longer if the person was weak or impaired or chronically ill prior to being hospitalized.
It sounds to me like first she needs to get through this acute hospitalization, and then you can see where things are at. Good luck!
My 86 year old father had a fibulator input. Before the surgery he had a very difficult time breathing. He now has delirium. We is in a rehabilitation center for therapy. However, he gets agitated, tried to leave the center and has confusion. Our doctor has prescribed risperidone. He has been on this medication for 2 days. He is still confused. My concern is for his safety. He is not able to come home and with this confusion should we consider a facility that provides memory care. This is so difficult and my family does not know what to do.
Sorry for delayed reply and sorry to hear of your father’s delirium. Risperidone and other antipsychotics have not generally been shown to help delirium resolve, they mostly mask the more agitated symptoms by causing some dampening of brain activity.
Generally to recover from delirium, people need rest, a restorative environment, and time. Getting out of bed and walking regularly also helps, it’s part of the body settling into a normal rhythm (lying in bed all day does not feel normal to the body). Of course, when people are confused, they need reassurance and also some level of supervision. Personally, I think many older adults feel better when they are in familiar surroundings, but it can be hard for families to provide the necessary supervision and help while the older person is recovering.
I hope he’s gotten better at this point. If not, I would recommend talking with his health providers about how he is doing, and a social worker can help you brainstorm ways to get him the care and support he needs. Good luck!
My dad has been very confused and was taken into hospital last Tuesday. He has rheumatoid arthritis and diabetes, and hasn’t been taking his meds properly or eating much. He has been saying how much pain he was in. Also he was very constipated. Since being in hospital he has had laxatives and His meds being controlled better. He is due to get a CT scan but I feel hes definitely less confused. Does this sound like delirium?
Yes, it does sound like it could be delirium. I would recommend you ask his doctors for more information, they should be able to advise you. That is great if he is already better! Good luck!
My father is 93 years old and had a prostate cancer 10 years ago. He is in remission and no longer have prostate cancer. However, as a result of the radiation, he has been having some bladder bleeding due to the thinning of the bladder wall and has been on a catheter continuously for over a year. A Homehealth nurse would come to the house and flush or change it once a month or as needed. The catheter has been giving him UTI on and off and his doctor would prescribe antibiotics. A couple of months ago, he has been paranoid and aggressive solely towards my mom. His mind is still sharp as he can carry on a conversation and would remember everything. He never exhibited suicidal tendencies until a month ago, he got suicidal to the point that he called 911, police came and eventually the paramedics took him to the ER and was put on a 5150 hold and was sent to a psych hospital. The hospital medicated him so bad that he was drooling and shaking. So we begged them to release him to a skilled nursing facility as he is not psychotic. The psych doctor thought it could have been the UTI that caused him to have delirium. He is still at the rehab and taking risperdal 0.125 mg and trazedone. It has been a rollercoaster ride because he would be in a good mood but then calls my Mom and goes back to the old paranoia accusing her of infidelity. My mom is 83 years old with osteoporosis and hunched back. Prior to this incident, he has shown some aggressive behavior and throwing stuff or threatening to harm my Mom. He is still at the rehab but I fear for my mom’s safety if he comes home. He is only allowed for a short stay and then he can come home or go to an assisted living facility. Trying to figure out if the risperdal is the right medicine for him. The Neuropsychologyst who evaluated him says he doesn’t exhibit any dementia and that he was alert and in a good mood. That is the irony of it, he doesn’t show any aggression towards the staff or to us – only to my Mom. Does this sound like delirium? I don’t know what to do – I need help! Thank you and I appreciate this forum. It’s been very informative.
Hm. Well, at age 93, his brain in general probably has underlying damage and is very vulnerable. If he was already showing signs of paranoia and delusions a few months ago, my guess is that he’s developing some chronic thinking problems, which will likely get worse when he has a UTI or otherwise is under physical stress.
Drugs like rispderdal can sometimes reduce aggression or frank paranoia, but they also increase falls and can cause sedation. I cover those types of drugs and their risks here: 5 Types of Medication Used to Treat Difficult Dementia Behaviors
Honestly, he might get a little better as he recovers from this hospital stay, but since he started having the problems a few months ago (and the bladder issue is a chronic problem), I think it’s quite likely that he will continue to have these problems, and they might slowly get worse. So starting to plan for a different care arrangement eventually may make sense. If you’re concerned for your mother’s safety, it would be good if you or someone could stay with her and your father once he comes home. You’ll have to see what the situation is like.
Good luck!
My dad is 67 years old and has not been eating well since 4 months ago. He’s a heavy smoker and drinks hard liquor on a daily basis for more than 30 years now. He needs assistance in walking now due to lack of nutritions.
He has been admitted to hospital last Saturday as his potassium level is very low and has been on and off confused state.
He was fine on Thursday and Friday but when Saturday comes, he started talking nonsensical stuffs, he couldn’t even tell us where he is now and keeps wanting to go home.
We are really worried on his condition and not sure how long will he take to recover. My mum can’t care for him alone even if he goes back home. The doctors can’t give a concrete answer to how and why is he acting like this. They tied him down to the bed as he could turn violent.
It’s really heart breaking for family member like us.
Sorry to hear of this story, it does indeed sound worrisome and very sad. It could indeed be delirium. Another possibility, if you say he drinks hard liquor every day, would be that alcohol withdrawal is playing a role.
I hope that by this point, the doctors were able to help stabilize him, and that he gets better soon. good luck!
Hi there. My father (81) has delirium following cancer surgery in January. We moved him to an assisted living home and our family visits as often as we can. But I wonder if there’s anything you could suggest that might give him something to do during the day. He stares at the TV (seems to prefer things like The Price is Right and court shows) but he can’t follow storylines well enough to watch a movie. He also has no interest these days in reading a newspaper (he scans it but doesn’t absorb it). He just rests a lot, but I would love if you could suggest something for him to do. Puzzles maybe?
Thanks for reading and for all your responses. Very insightful!
Rick
Hi Rick
I’m so glad to hear that you are able to frequently visit your dad! There are a lot of puzzles, games and apps that are designed to boost brain performance, and some of them have been shown to do so (or at least people can improve their performance at the tasks in the game, but whether this translates into better function or more independence has not really been demonstrated).
The best kind of activity is one that will actively engage your father, both physically and mentally. If there are exercise classes or social events at his facility, he should be encouraged to attend (and may need someone to knock on his door and invite him until it becomes a habit for him). Eating his meals in a dining room with others is also a therapeutic intervention. Hope that helps.
Hello – lots of good information here! I am searching for input on finding a care team equipped to understand and treat delirium in my 83 year old mother-in-law.
4 weeks ago she had a knee replacement. Prior to the surgery, she had full physical and cognitive function – no apparent diminished capacity. Within about 8 hours post-op, she was in what we later found out was hospital-induced delirium – severe aggression, confusion, delusions, etc. Her Dr. felt like it would clear over time. She was starting to get a bit better, with moments/hours of clarity. After 8 days, she was moved to a skilled-nursing facility for Rehab, with orders from her Dr. to cease all meds in order to promote cognitive clarity.
Her mental state was up and down over a period of a few days, but progressed into being pretty poor again, particularly at night. She was very combative with the staff, very confused and couldn’t seem to interpret reality from her dreams, etc. They “released” her (kicked her out) at 11:00pm on a Friday night 2 weeks ago to have an ambulance come get her and take her to the hospital for extreme aggression.
The ER determined she had a UTI, and we quickly learned that can add to the confusion. We also found out the rehab center had her on a plethora of drugs to calm her down. She was treated in the hospital for a UTI, but her confusion continued off and on. They initially had her on only a small dose of Olazapine, Because her mental status had not cleared but her UTI did, they moved her to the Senior Behavioral Health Unit after 5 days, and she has now been there for 5 days. They just seem to be pumping her full of different anti-psychotics (Respidol for 3 days, then Halidol & Ativan) and no real treatment plan. Her nursing staff and psychiatrist also change frequently, and when I spoke with her new assigned psychiatrist today he had no history of the last 4 weeks, thought she had long term dementia and was surprised to find out she had not, etc. In fact, when I questioned her treatment plan the nurse stated they are just trying to manage her, and just wanted to push me off on a social worker.
I am not at all satisfied with her care team. I want to find a physician that understands delirium and can actually present a recommended plan and prognosis, but am unsure of how to do so. Are there some resources that you can recommend for finding a Dr. that specializes in these issues? The family is very frustrated and we don’t know where to go for help.
Thanks! Anita
Hi Anita. I’m sorry to hear about your mother-in-law’s rough time, and unfortunately it’s an all too common story! You are really thinking the right way about avoiding sedating medications, promoting routine, ruling out infection and other aspects of delirium prevention and care.
Being in Canada, I am not sure how to advise about trying to get a different care team. I wonder if it is possible to ask for a consultation with a Geriatrician? This article from Dr. Kernisan may be helpful.