Pop quiz: What aging 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. In my opinion, this is one of the most important aging health problems for older adults to be aware of. It’s also vital for family caregivers to know about this condition, since families can be integral to preventing and detecting delirium.
In this article, I’ll explain just what delirium is, and how it compares to dementia. Then I’ll share 10 things you should know, and what you can do.
What is Delirium
Delirium is a state of worse-than-usual mental confusion, brought on by some type of unusual stress on the body or mind. It’s sometimes referred to as an “acute confusional state,” because it develops fairly quickly (e.g., over hours to days), whereas mental confusion due to Alzheimer’s or another dementia usually develops over a long time.
The key symptom of delirium is that the person develops difficulty focusing or paying attention. Delirium also often causes a variety of other cognitive symptoms, such as memory problems, language problems, disorientation, or even vivid hallucinations. In most cases, the symptoms “fluctuate,” with the person appearing better at certain times and worse at other times, especially later in the day.
Delirium is usually triggered by a medical illness, or by the stress of hospitalization, especially if the hospitalization includes surgery and anesthesia. However, in people who have especially vulnerable brains (such as those with Alzheimer’s or another dementia), delirium can be provoked by medication side-effects or less severe illnesses.
It’s much more common than many people realize: about 30% of older adults experience delirium at some point during a hospitalization.
That post-operative confusion that older adults often experience? That’s delirium.
The way your elderly mother with dementia gets twice as confused when she has a urinary tract infection? That’s delirium too.
Or the common phenomenon of “ICU psychosis”? That too is delirium.
What Causes Delirium?
In older adults, delirium often has multiple causes and contributors. These can include:
- Infection
- Other serious medical illness (e.g. heart attack, kidney failure, stroke, and more)
- Metabolic imbalances (e.g. abnormal blood levels of sodium, calcium, or other electrolytes)
- Dehydration
- Medication side-effects
- Sleep deprivation
- Uncontrolled pain
- Sensory impairment (e.g. poor vision and hearing, which can worsen if the person is lacking their usual glasses or hearing aids)
- Alcohol withdrawal
Delirium vs. Dementia
People often confuse delirium and dementia, because both conditions cause confusion and appear superficially similar. Furthermore, people with dementia are actually quite prone to develop delirium. That’s because delirium is basically a reflection of the brain going haywire when it gets overloaded by the stress of illness or toxins, and brains with dementia get overloaded more easily.
In fact, the more vulnerable a person’s brain is, the less it takes to tip them into delirium. So a younger person generally has to be very very sick to become delirious. But a frail older person with Alzheimer’s might become delirious just from being stressed and sleep-deprived while in the hospital.
Why Delirium is Such an Important Problem
There are three major reasons why delirium is an important problem for us all to prevent, detect, and manage.
First, delirium is a sign of illness or stress on the body and mind. So if a person becomes delirious, it’s important to identify the underlying problems – such as an infection or untreated pain – and correct them, so that the person can heal and improve.
The second reason delirium is important is that a confused person is at higher risk for falls and injuries during the period of delirium.
The third reason is that delirium often causes serious consequences related to health and well-being.
In the short-term, delirium increases the length of hospital stays, and has been linked to a higher chance of dying during hospitalization. In the longer-term, delirium has been linked to worse health outcomes, such as declines in independence, and even acceleration of cognitive decline.
Now let’s cover 10 more important facts you should know about delirium, especially if you’re concerned about an aging parent or other older relative.
10 Things to Know About Delirium, and What You Can Do
1.Delirium is extremely common in aging adults.
Almost a third of adults aged 65 and older experience delirium at some point during a hospitalization, with delirium being even more common in the intensive care unit, where it’s been found to affect 70% of patients. Delirium is also common in rehabilitation units, with one study finding that 16% of patients were experiencing delirium.
Delirium is less common in the outpatient setting (e.g. home, assisted-living, or primary care office). But it still can occur when an older adults gets sick or is affected by medications, especially if the person has a dementia such as Alzheimer’s.
What to do: Learn about delirium, so that you can help your parent reduce the risk, get help quickly if needed, and better understand what to expect if your parent does develop delirium. You should be especially be prepared to spot delirium if your parent or loved one is hospitalized, or has a dementia diagnosis. Don’t assume this is a rare problem that probably won’t affect your family. For more on hospital delirium, see Hospital Delirium: What to know & do.
2. Delirium can make a person quieter.
Although people often think of delirium meaning as a state of agitation and or restlessness, many older delirious people get quieter instead. This is called hypoactive delirium. It’s still linked with difficulty focusing attention, fluctuating symptoms, and worse than usual thinking. It’s also linked with poor outcomes. But it’s of course harder for people to notice, since there’s little “raving” or restlessness to catch people’s attention.
What to do: Be alert to those signs of difficulty focusing and worse-than-usual confusion, even if your parent seems quiet and isn’t agitated. Tell the hospital staff if you think your parent may be having hypoactive delirium. In the hospital, it’s normal for older patients to be tired. It’s not normal for them to have a lot more difficulty than usual making sense of what you say to them.
3. Delirium is often missed by hospital staff.
Despite the fact that delirium is extremely common, it is often missed in hospitalized older adults, with some reports estimating it’s being missed 70% of the time. That’s because busy hospital staff will have trouble realizing that an older person’s confusion is new or worse-than-usual. This is especially true for people who either look quite old – in which case hospital staff may assume the person has Alzheimer’s – or have a diagnosis of dementia in their chart.
What to do: You must be prepared to speak up if you notice that your parent isn’t in his or her usual state of mind. Hypoactive delirium is especially easy for hospital staff to miss. Hospitals are trying to improve delirium prevention and detection, but we all benefit when families help out. Remember, no hospital person knows your parent the way that you do.
4. Delirium can be the only outward sign of a potentially life-threatening problem.
Although delirium can be brought on or worsened by “little things” such as sleep deprivation or untreated constipation, it can also be a sign of a very serious medical problem. For instance, older adults have been known to become delirious in response to urinary tract infections, pneumonia, and heart attacks.
In general, it tends to be older persons with dementia who are most likely to show delirium as the only outward symptom of a very serious medical illness. But whether or not your older relative has dementia, if you notice delirium, you’ll want to get a medical evaluation as soon as possible.
What to do: Again, if you notice new or worse-than-usual mental functioning, you must bring it up and get your parent medically evaluated without delay. For older adults who are at home or in assisted -living, you should call the primary care doctor’s office, so that a nurse or doctor can help you determine whether you need an urgent care visit versus an emergency room evaluation.
5. Delirium often has multiple underlying causes.
In older adults with delirium, we often end up identifying several problems that collectively might be overwhelming an older person’s mental resilience. Along with serious medical illnesses, common contributors/causes for delirium include medication side-effects (especially medications that are sedating or affect brain function), anesthesia, blood electrolyte imbalances, sleep deprivation, lack of hearing aids and glasses, and uncontrolled pain or constipation. Substance abuse or withdrawal can also provoke delirium.
What to do: To prevent delirium, learn about common contributors and try to avoid them or manage them proactively. For instance, if you have a choice regarding where to hospitalize your parent, some hospitals have “acute care for elders” units that try to minimize sleep deprivation and other hospital-related stressors. If your parent does develop delirium, realize that there is often not a single “smoking gun” when it comes to delirium. A good delirium evaluation will attempt to identify and correct as many factors as possible.
6. Delirium is diagnosed by clinical evaluation.
To diagnose delirium, a doctor first has to notice – or be alerted to – the fact that a person may not be in his or her usual state of mind. Experts recommend that doctors then use the Confusion Assessment Method (CAM), which describes four features that doctors must assess. Delirium can be diagnosed if a patient’s symptoms include “acute onset and fluctuating course,” “difficulty paying attention,” and then either “disorganized thinking” or “altered level of consciousness.”
Delirium cannot be diagnosed by lab tests or scans. However, if an older adult is diagnosed with delirium, doctors generally should order tests and review medications, in order to identify factors that have caused or worsened the delirium.
What to do: Again, the most important thing for you to do is to get help for your loved one if you notice worse-than-usual confusion or difficulty focusing. Although families have historically not had a major role in delirium diagnosis, delirium experts have developed a family version of the CAM (FAM-CAM), which is designed for non-clinicians and has been shown to help detect delirium.
7. Delirium is treated by identifying and reversing triggers, and providing supportive care.
Delirium treatment requires a care team to take a three-pronged approach.
- Health providers must identify and reverse the illness or problems provoking the delirium.
- They have to manage any agitation or restless behavior, which can be tricky since a fair number of sedating medications can worsen delirium.
- The safest approach is a reassuring presence (family is best, but hospitals sometimes also provide a “sitter”) to be with the person, plus improve the environment if possible (e.g. a room with a window and natural light).
- The once-popular practice of physically restraining agitated older adults has been shown to sometimes worsen delirium, and should be avoided if possible.
- The care team needs to provide general supportive care to help the brain and body recover.
What to do: The reassuring presence of family is often key to providing a supportive environment that promotes delirium recovery. You can also help by making sure your loved one has glasses and hearing aids, and by alerting the doctors if you notice pain or constipation. Ask the clinical team how you can assist, if restlessness or agitation are an issue. Bear in mind that physical restraints should be avoided, as there are generally safer ways to manage agitation in delirium.
8. It can take older adults a long time to fully recover from delirium.
Most people are noticeably better within a few days, once the delirium triggers have been addressed. But it can take weeks, or even months, for some aging adults to fully recover.
For instance, a study of older heart surgery patients found that delirium occurred in 46% of the patients. After 6 months, 40% of those who had developed delirium still hadn’t recovered to their pre-hospital cognitive abilities.
What to do: If your parent or someone you love is diagnosed with delirium, don’t be surprised if it takes quite a while for him or her to fully recover. It’s good to be prepared to offer extra help during this period of time. You can facilitate recovery by creating a restful recuperation environment that minimizes mental stress and promotes physical well-being.
9. Delirium has been associated with accelerated cognitive decline and with developing dementia.
This is unfortunate, but true, especially in people who already have Alzheimer’s or another type of dementia. A 2009 study found that in such persons, delirium during hospitalization is linked to a much faster cognitive decline in the following year. A 2012 study reached similar conclusions, estimating that cognition declined about twice as quickly after delirium in the hospital.
In older adults who don’t have dementia, studies have found that delirium increases the risk of later developing dementia.
What to do: Experts aren’t sure what can be done to counter this unfortunate consequence of delirium, other than to try to optimize brain well-being in general. (For this, I suggest avoiding risky medications, getting enough exercise and sleep, being socially and intellectually active, and avoiding future delirium if possible.)
The main thing to know is that delirium has serious consequences, so it’s often worth it for a family to be careful about surgery in an older person, and it’s good to learn about delirium prevention (see below).
10. Delirium is preventable, although not all cases can be prevented.
Experts estimate that delirium is preventable in about 40% of cases. Preventive strategies are meant to reduce stress and strain on an older person, and also try to minimize delirium triggers, such as uncontrolled pain or risky medications.
In the hospital setting, programs such as the Hospital Elder Life Program (HELP) for Prevention of Delirium have been shown to work. For ideas on how families can help, see this family tip sheet from the Hospital Elder Life Program. For instance, families can help reorient a relative in the hospital, ensure that glasses and hearing aids are available, and provide a reassuring presence to counter the stress of the hospital setting.
Less is known about preventing delirium in the home setting. However, since taking anticholinergic medications (such as sedating antihistamines) has been linked with hospitalizations for confusion, you can probably prevent delirium by learning to spot risky medications your parent might be taking.
What to do: To prevent hospital delirium, carefully weigh the risks and benefits before proceeding with elective surgery. If your parent must be hospitalized, choose a facility using the HELP program or with an Acute Care for Elders unit if possible. Be sure to read HELP’s tips for families on preventing hospital delirium.
Remember, delirium is common and can be the only outward sign of a serious medical problem.
By educating yourself and helping your older loved ones be proactive about prevention, you can reduce the chance of harm from this condition.
And if you do notice symptoms of delirium, make sure to tell the doctors! This will help your parent get the evaluation and treatment that he or she needs.
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 older adults in the Intensive Care Unit, finding that 43.5% had hypoactive delirium
- An article finding that older patients 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!
This article was first written by Dr. Kernisan in July 2015, and was reviewed and updated in July 2022.
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!
Love your articles on delirium. Also leg swelling. Just do not know how to reply. Here goes,
I was hositalized one day before 81st birthday for hypothermia because Denver Archdiocese Housing Corporation has no t hermostats and it was either turn heat on or off, freeze or burn up from too much heat. My body temp was 93.8 degrees and I was found nonresponding. I wish they had let me alone. Old people do not need to be revived. Let them go! I hate it that I became so ill because people cannot let older folks go. I since have DNR and MOST form so won’t be bothered again by interfering people. I ended up with delirium and then they kept trying to treat me for everything and my primary care doctor at another medical center did not protect me. The entire episode resulted in Archdiocese of Denver hud housing trying to evict me. I had to move.
Also, I am smarter than the average 81 year old and remember every evil thing they did, drugging me with antipsychotics and other disabling drugs and putting in piccine which I removed to stop drugging me. It is a horror story I posted online. I never wanted to be revived.
I’m sorry you’re having so much stress about your housing, and it sounds like it’s affecting your health.
When you mention DNR, or “Do Not Resuscitate”, you express a sentiment that I’ve heard on occasion from some of my patients. Dr. K has a good article about advance care planning, including a discussion of the POLST (Portable Medical Orders or Physician Orders for Life sustaining Therapy). You can check out that article here: https://betterhealthwhileaging.net/polst-resources-tips-avoid-pitfalls/
It’s vital to let the people in our lives who may act as attorneys or substitute decision makers know about our preferences for medical care in the case we can’t speak for ourselves. That way, if a person is too ill to convey their wishes, their family member can do so for them.
In my province we have a “DNR” form that can be signed by a doctor and posted in the home, so that an emergency medical responder can see it and know not proceed with CPR or other interventions.
I’m sorry that you had such a negative experience and I would encourage you to have a discussion with the people in your life about what your wishes are, to avoid a similar situation in the future.
Please comment on possible causes of the early morning delirium . My mother too has delirium episodes usually between 2-4 am but may also be affected during daytime . Would an electrolyte imbalance or elevated/ lowered blood sugar ; blood pressure be responsible ? Who would be best to diagnose – a neurologist/ gerontologist?
Thank you
There can be daily fluctuations in the levels of alertness and cognitive performance in a person living with dementia. You don’t mention whether that’s the case with your mom.
It’s possible that significant sudden changes in blood chemistry or blood pressure could cause confusional episodes but there may be other triggers related to the environment, medications, or some other factor that’s more likely to be the culprit.
A geriatrician would be able to do a comprehensive assessment and help iron out the issues and give you some clarity.
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.
My grandmother is 81 years old and has always been in perfect health. No out patient procedures, no surgeries. She was diagnosed with stage 3 kidney disease, but is just being “monitored” for any changes. Over the past month she has complained of a “fluttering” in her ear and severe headaches. Then a few days after Thanksgiving, she forgot a phone conversation she had held earlier in the day and could not remember what she had for breakfast. The next day, we took her to her primary care physician where he said he still didn’t see anything in her ear and she was probably beginning to show signs of dementia or Alzheimer’s. We were to return for follow up in 6 weeks. However, she progressively got worse. She would only give one word answers when asked questions, typically yes or no. Sometimes, I don’t know. She wasn’t really able to carry on any type of conversation and this got worse over a period of days. I took her to an emergency room. They ran urinalysis, blood work and ct scan. No infection and metabololic panel looked normal. CT scan showed age related, shrinkage of brain which he then eluded to dementia. I asked if dementia, would we not have gradually seen some type of cognitive decline? He said it was possible that she could have had a ministroke that exacerbated the condition. He then sent us home to again follow up with PCP. Every day her mental state has worsened. Last week, we saw her PCP and he prescribed her busiprone and trazadone. This week, there has been no improvement and her condition has actually worsened. She is now fighting us with everything we ask or need her to do. She won’t eat, she won’t take her meds, she won’t bath. She is cussing (which is NOT at all normal), she tells my mother, whom is caring for her, to go home and leave her alone! TSo again, we take her back to PCP yesterday and we demand he send her to hospital for further evaluation. (She actually laid herself in the floor and had a tantrum to try to avoid going to the doctor. My mom and uncle had to DRAG her out and basically put her in the vehicle) He says that there is NOTHING in any of her test results from ER visit that is making him think she has anything other than cognitive impairment. I said what about all this medicine that she is prescribed, could she be suffering from seratonin syndrome. He said that it could be possible than in an attempt to make her better, prescribing her the busiprone and trazadone has only made her worse. He stopped all meds except for : Lexapro, Ativan, Lisinopril and a thyroid medication. He said to return again in a week to see if that change in meds has helped but also implied that we should be getting ourselves prepared as this condition will probably not improve.
As I have mentioned before, my grandmother has NEVER done anything to make us think she was getting dementia. It is no exaggeration when I say this literally sprang up over night and has just gotten worse with each day. I must note that prior to the doctor giving her busiprone and trazadone, he had also prescribed her Remeron(30mg) which she was to take for sleep and for several weeks leading up to this change in behavior, she complained about all the dreams she would have and would often times have a hard time “shaking” them when she woke.
We are so confused and do not understand any of what is going on. I believe that someone else needs to take a second look at her, though I am no sure in her agitated state, how we would get her to go or cooperate. I am thinking a neurologist but would a mental health facility be better? Any type of advice you could give us would so greatly appreciated. She has been this way since Thanksgiving and it sure would be nice to know that if there is something else going on with her, other than dementia, we know about it because maybe we can HELP her!
I’m sorry to hear that your grandmother is having so much difficulty and it must be very hard on your family right now. It sounds like you are all noticing some significant changes and seeking help as best you can.
The medications that you mention are mostly prescribed for depression, anxiety, and insomnia (Buspar, Lexapro, Remeron and Trazadone), so if I saw someone who had been prescribed those medications, I would be curious about whether they had struggled with those conditions. Dementia can certainly cause changes in behaviour and language skills, but those psychiatric conditions could do that too. Just to make things more complicated, the medications themselves can have side effects that can bring abut such symptoms as well. See this video about anticholinergic medications for example.
A Geriatrician would be able to sift through all of the different medications, underlying medical issues and current behaviour changes, and give some advice about how to get clarity on the diagnosis and treatment. I would advise someone in your situation to advocate for a referral form the PCP. Best of luck.
My mother is 95 and has had Alzheimer disease for almost a decade. But she has been at a constant level and has recognized all of the immediate family and been able to enjoy our stories and respond appropriately to our conversations. But then she developed a urinary track infection that was not identified for two weeks or so. She then received antibiotics but became significantly more detached and unsteady enough that her caregivers in the memory home have her in a wheelchair for fear she will fall if she continues using her walker. Her doctor checked her out after she finished the antibiotic. They took a blood test but did not find anything wrong. At this point the advice is that we move forward with comfort care. We are heartbroken at the sudden decline and it certainly seems from your article that she may have suffered from delirium from the UTI. I am left wondering if we should be taking other action in trying to get more clarity and help for her, or if this is just the unfortunate turn of events that we deal with moving forward
I’m so sorry to hear about the changes you’re seeing in your mom. This is a familiar story when a seemingly small challenge like a UTI can be a major setback. Unfortunately, this can lead to a cascade of changes, like using a wheelchair more often, that will then compound the difficulties (through reducing mobility, contributing to weakness and falls risk). Sometimes, this is irreversible, and does lead to an ongoing decline where a focus on comfort makes the most sense.
In my experience as a Geriatrician, though, an older person can often rally with a return to regular routine, good nutrition, physical activity and trimming away any unnecessary medications. A consultation from a Geriatrician might be helpful to identify any reversible issues that the team at the memory home have missed.
This is a very informative forum ! My dad is 96 , and in incredibly good health , has lived on his own w/ some assistance. Last night he was admitted to a hospital w/what we thought was a bowel obstruction. Turns out severe constipation that had no doubt been going on for months . A 2 day aggressive process of “cleaning him out” ensued & let to serious problems with his kidney #’s . 2 days in he also “changed” mentally . Talking utter nonsense, spinning tails if you will . His routine was so out of whack as were his electrolytes & potassium levels . He would be ok one minute then totally unrational the next. Could all this be classified as hospital delirium? He has no history of any dementia or Alzheimer’s, & cognitively was fine before entering the hospital. He stayed a week & entered a rehab facility yesterday. He is better , much better , but the staff & myself In talking over the phone with him still notice a bit forgetfulness , but thankfully not spinning any tales . What do you think his chances are to be back to normal cognitive behavior?
Hi Kelly and sorry to hear about your dad’s difficulties.
It sounds like you’re describing a delirium with the fluctuations, “spinning tales” (which we might call delusions or hallucinations) and changes in concentration and level of alertness. Thankfully, delirium almost always gets better, although for some the return to the prior baseline level of thinking and function isn’t 100%. It’s difficult to predict how much a person ill recover and only time will tell, really.
There’s no pill to “cure” delirium, and the best treatment includes physical exercise, promoting restful sleep, and getting back into a routine. I made a YouTube video about delirium which you can watch here: https://youtu.be/uKp3sGwk4Tc
You might also be interested in this article about constipation. Your story is a good reminder that a seemingly minor challenge like constipation can lead to serious problems.
Thanks again for your comment and I’m so glad you find the website informative!
My 91 year old mom has been officially diagnosed with Alzheimers two years ago. I am certain she had it several years before I brought her to a specialist. She now lives with me and has for about 1.5 years. She has had 3 UTI’s which as soon as I detected and got her treated the delirium seemed to clear in about 1 day. Recently she was in the hospital for very mild fluid in one lung and possible UTI (not sure if it was never really cleared up or if it was new. Now home for over two weeks and a sudden onset of delirium and massive confusion. I brought her to urgent care and everything came out fine. Great vitals, no UTI and chest xray clear. Today she didnt know me and I played her dead sister for most of the day as that seemed to calm her. Her doctor did prescribe 5mg of Adavan (they gave that to her on one night in the hospitaL) her doctor was reluctant but understood that it was important since she got up 3x in one night and tried to use my stove. I have now been referred to a psychiatrist for management of her meds. Can this delirium just go away? I fear this will be the difference between caring for her at home or in a home.
That sounds like a really difficult situation and I’m sorry your mom has had a tough time.
Delirium can take a while to improve, days or even weeks or longer. And it can wax and wane as you describe. There’s no magic bullet medication that clears it up and unfortunately, benzodiazepines like ativan (lorazepam) can cause more confusion and sedation, although it can seem to relax the person and promote sleep. It’s not a good idea to use ativan on a long term basis.
A psychiatrist with expertise in Geriatrics should be able to provide some guidance with respect to medications, but often it takes time and routine to see the delirium clear.
The inability to stay with our elder loved ones while hospitalized during the COVID pandemic has been a huge disruption in our ability to minimize delirium. We helplessly remain outside while our hospitalized loved ones move further into confusion to the point that they often can’t even use digital communication to connect with us. It was a disaster for my father (age 91) after he fell and broke his pelvis – both at hospital ER (where we weren’t allowed to come in and assist with decision-making, even though he has documented dementia) and the rehab center, where we couldn’t see him. After just days, he was so confused that he had no idea where he was or why, and we finally ended up pulling him out on hospice care to die at home. He was able to re-orient once we got him home and cared for him ourselves, but it was a hard journey to that peaceful death.
Gretchen, I’m so sorry that your father went through that experience, and I’m so glad he was able to return home for the last part of his life. I sincerely hope that we take a long hard look at the consequences of isolation and separation balanced against the risks of infection, before the next crisis comes.
It can be traumatizing to see a family member go through delirium so I hope you’re getting the support you need.
Hi, my Mom has not officially been diagnosed (refuses testing) but has a dementia of some kind, most likely vascular. Some days are better than other days as far as her abilities and speech. I have noticed that the day after she eats sugar her cognitive abilities are diminished. Have you ever experienced this? She normally drinks a boost everyday, two if I do not see her. Yesterday we went out to celebrate and each got a 20 oz chocolate shake. Today she did not know how to get dressed (she always dresses herself) and has been confused all day.
Additionally, over the last few days I have noticed that she has been subdued, somewhat withdrawn and more confused than usual. Her sleep is irregular and she fights going to bed, going to sleep so she doesn’t get the quality nor quantity of sleep she should. Could this be delirium also?
So, my two questions are: can sugar affect cognition and could my Mom be experiencing delirium also?
Thanks so much for any help you can provide me.
Sincerely, Donna
Hi Donna. Those are good questions.
There’s no good evidence that sugar intake causes short term effects on cognitive performance in dementia, but it can cause a short-term energy boost, followed by a “crash” which can cause fatigue and “brain fog” type symptoms. This usually lasts hours though, not days.
Delirium is marked by a change in level of alertness, concentration, attention and even level of consciousness (with drowsiness or hypervigilance), so it’s hard to tell if the changes you describe fit this pattern. It’s typical for people living with dementia to have days when things go better than others, just like in those who are not living with dementia. Having had a poor sleep can definitely increase the likelihood of a “bad day” .
It can be helpful to keep notes of a person’s activity, sleep and diet patterns to see if they correlate with changes in behaviour, or if it’s just a coincidence.
Could you please provide a printable version of your articles? I like to print them and keep as references and it’s much easier to read and study than sitting at my computer, especially given I’m taking care of my husband with Parkinson’s.
Thank you.
Hi Norma and glad you like the article. If you scroll down to the very bottom, there’s a little green printer icon that you can click on to get to the printable article.
Hello Dr. Kernisan,
Thank you so much for this information. It’s so important. I really appreciate all of your articles. I just wanted to make the readers aware of what happened to my mom. She’s only 74yo-over night-became very delirious-couldn’t focus on anything, couldn’t play games anymore, couldn’t read the paper. Had to help her get dressed. It was awful. The doctor would not listen to me that she was perfectly fine the week before. He told me she had vascular dementia. Long story short-turns out it was a combo of Cymbalta which a Neurologist gave her for her migraines and took her off cold turkey on her Effexor which she had been taking with no problems for years. It really messed her up. She practically became a vegetable. All of the medical people didn’t understand or listen. The other neurologist we saw wanted to put a shunt in her brain. We got her off the Cymbalta. We found out she also had an acute UTI that turned into a Kidney Infection-she showed no symptoms except cognitively. She started slurring her words and babbling. She slid to the floor and we couldn’t get her to move or get up. She was like a rag doll. They put her in the Hospital and gave her an IV antibiotic and she was finally on the mend. Today, a year later-she is back to herself and can read, watch TV, and play games with me. So, if your parent becomes delirious overnight, definitely look at the medication and check for a UTI. I looked up Cymbalta and it is known to cause this problem with older people. Why didn’t the Neurologist tell us this?? Very upset and hard to trust doctors anymore. I hope we never have to go through this again but will be wiser the next time. Patients-stand up for yourself. Keep fighting when you know something is wrong.
Thanks for sharing your story, and I’m so sorry you and your family went through that. How wonderful that your mom is back to herself again.
It’s common to hear of how concerns are dismissed as “just getting old” or as “nothing new” and that can lead to delays of diagnosis and correct treatment, as well as the suffering you describe. Your point about advocacy and not giving up is spot on! It’s a constant fight against ageism, ableism, sexism and the constraints of an overburdened health care system. Looking at medications as a cause for new symptoms is a Geriatric must-do.
Hearing that the information on Dr. K’s website is so gratifying and means the world.
Hello, thank you for your article. Our 93 year old Mum has been doing really well until early last year when she started taking opioid pain relief and nerve blockers for arthritis and referred leg pain, and also developed a chronic venous leg ulcer. A terrible rash developed, followed by the start of delusions of infestation/parasitosis.
She doesn’t have dementia, but the description of delirium fits with a rapid decline we’ve seen in her over the past two months. She has been taking 5mg of Aripiprazole daily since late last year for the delusions, but they haven’t subsided, they seem worse, interrupt her sleep, cause her to damage her skin and generally distress her. We’ve tried numerous pain meds, Tapentadol seems the best tolerated. She’s started seeing people in her home, deceased family members and strangers, while dreaming and awake. Her psychiatrist wants to up the Aripiprazole dose, we want to stop it to see if it’s causing this decline, he thinks her worsening cognitive state is due to decreased blood perfusion in her brain. We’re very concerned as she lives alone, by her own very firm choice, with daily nursing (for leg ulcer) and family support. Next step is hypnosis and another geriatrician, the first one touted her rash as “abuse” before she’d even started gathering information regarding mum’s care/living situation. Very distressing times.
Hi Jayne, I’m glad the article was helpful.
It sounds like your mum has really suffered with pain and medication side effects. I wouldn’t be surprised if delirium occurred in a situation like the one you describe. It does sound as though your mom has support from nursing and her psychiatrist, and that’s reassuring.
It’s so hard to know if a medication should be stopped, to see if it’s causing the symptoms, or if it should be increased to see if they help with the hallucinations – this is a dilemma that I’ve grappled with many times! What can be very helpful is trying to get some objective data on how the behaviors and symptoms change in response to the medication adjustments. Keeping a calendar with notes about what’s happening from day to day can be a great guide to what to do.
I’ve never used hypnosis in a delirium scenario but it’s an interesting idea.
Another piece is to look after yourselves while caring for your mom and trying to respect her wish to stay at home. As you’ve likely experienced, this can be a long journey.
Dr. Didyk,
First, thank you for this excellent resource and your public service. My 88 year-old mother just returned to our home (where she resides) from a 6 week stay in a rehab facility. The initial 3 days home were uneventful but now her early morning delirium is affecting her sleep; to compound matters, she has always had PTSD from WWII which is resurfacing once again. I can deal with the delirium but I am wondering if we should seek an alternative to Tramadol (used with her Tylenol) for pain management so she can do PT and sleep through the night without pain (and, ironically, I read above that pain contributes to delirium!). She also has started Allegra (low anticholinergic) and is given Trazadone PRN when she cannot sleep. She has also been started on Aricept at bedtime. My question to you is how much are these new meds contributing to her delirium and should the dosing be at another time than bedtime? She wears an external catheter at night so does not ambulate to the bathroom (reduces fall risk). She has been on Cymbalta bid for myalgia and underlying depression as well as Diltiazem, metoprolol and telmisartan for several years.
Thank you for your time.
I’m glad your mom is back home. It’s not unusual for older adults to be on a slew of new medications when discharged from hospital, and they may not all be meant to be used long term.
I usually administer Aricept in the morning, as it can cause a bit of activation and may also contribute to nightmares.
Pain is tricky to treat in the setting of a delirium, and non-medication treatments might be preferable (like massage, heat, ultrasound, acupuncture and physiotherapy). Cymbalta can have pain relieving properties as well, so this might be reasonable to review and see if the dose is optimal.
I also use melatonin for sleep instead of trazadone, which seems to cause less of a lingering “hangover” the next day.
A pharmacist can be a great resource when trying to sort out medications in an older adult, and I often collaborate with pharmacists to review a medication list.
Finally, an external catheter is less likely to cause infection than one that is connected to the bladder, but it can be worth checking for a UTI if new behavior changes occur.
I’ll add to all the stories. My father was 94 at the time he passed out and fell at home. This is 12/31/2019. It was discovered that he had a tumor in his abdomen that eventually burst in his intestine and required major emergency surgery to save his life. Needless to say, this was a major trauma on his body not to mention all the drugs for the surgery and post surgical recovery. Long story short, he got hospital delirium while at the hospital and it continued during his 4-week stay at a skilled nursing facility during his recover. We finally go him home mid-March, 2020 which he still had delirium.
Almost immediately he began to get more clear minded once in familiar surroundings. However, he never recovered to his pre-2019 cognition level. He had good days and bad days. And early on, his good days outnumbered his bad days. But more recently his bad days have outnumbered his good days. He is confused most of the day and hallucinates frequently.
It is now June, 2021. He will be 96 in July and he has slipped into dementia and pretty much everyday is an adventure with us. You never know what you will get each day. He sleeps and dreams. And many time, he wakes up still believing his dream state.
Initially, during the delirium onset, we tried to connect his misconception did our best to ground him back to reality and keep him calm. Now with dementia, we just go with the flow and try not to correct him because when we do we tend to agitate him.
It’s been a tough year and a half for us and we don’t hold any hope of getting our patriarch back. Our goal now is to keep him comfortable at home for as long as we can.
Thanks for adding your voice to the conversation, and I’m sorry to hear about all the challenges you’ve faced as a family.
A fall like the one you describe is commonly the beginning of a cascade of diagnoses and interventions, sometimes resulting in irreversible changes. The “good days” that you mention can be a real blessing, and often the goals of medical care shift to promote more of those good days rather than achieve a cure or return to prior function, and that’s OK, and usually more realistic.
It’s wonderful that your dad has a loving and supportive family, and that you’re so resourceful and adaptable as you see changes happen. I made a video about how to communicate with older adults with dementia which you might find interesting. You can watch it here: https://youtu.be/N0haz51Ll9s
My 72 year old wife had a kidney removed because of cancer when she was 70. Everything went well. Then She was diagnosed with lymph node cancer a few months ago and had 5 bouts of radiation. During this time she had bad pain in her stomach which was diagnosed has a tear in her abdomen which was leaking gas and air into her stomach. Successful surgery was done and she is in recovery, but she does not move at all after 5 days. She won’t get up for rehabilitation and says she wants to die and is fed up with everybody. She was a strong women and we have been married 54 years and I don’t understand her behaviour. Thanks
I’m sorry to hear about the tough time your wife has had, it sounds like a really rotten past few months for both of you.
Delirium is common in older adults after surgery, and can interfere with a person’s motivation to do rehab. It usually also causes lapses in attention or alertness, fluctuations, and even hallucinations, and can take weeks or even months to completely resolve.
When I hear about someone saying they’re fed up and want to die, I think about depression, and you can read my article about that here, or watch my video on YouTube. Depression is more common in those with medical issues, like cancer or chronic pain. It’s treatable with counselling, cognitive behavioral therapy, and medication, but needs to be diagnosed first. A depression might explain the symptoms you’re observing, and I would suggest asking her doctor about it.
Hi there, my mother is currently in hospital with suspected delirium. But of background information, my mother is 74 years old. She had lung surgery on 14th of Feb for treatment of lung cancer. She ended up staying in hospital for over 3 weeks. There were minor setbacks with her bladder control plus her drain port leaked but these all rectified themselves before discharge. She had been on strong pain relief but had been weaned off these and was on paracetamol only for pain when she was sent home. She came home on Tuesday the 8th of March and the first few nights, she was having vivid dreams and was disorientated. She thought she was still in the hospital. We thought she was just settling back in. Her mood was quite low too. She ended up visiting her GP on the Thursday as she was shaking and kept drifting off. Her blood pressure was high and he prescribed a short term course of medication for this. She is already on medication for BP and a heart arrhythmia. I visited her on the Friday and while her mood was still low, she was brighter in herself and I thought she was starting to come round. On Saturday morning when I spoke to her on the phone she was all muddled and started talking pure nonsense. She ended up being readmitted to hospital where chest xray, head ct and bloods have all been done and are fine. She us currently awaiting brain mri. I was with her all day Saturday and was able to visit her on Sunday and Monday. She is not herself at all. She has a vacant look on her face and was talking utter nonsense, speaking about things that never happened. Not engaging in conversation at all and very few moments of clarity. One of the doctors who she met with regards to her lung problems rang me on Wednesday to say they thought she was having a delirium. I was able to visit again in Friday even though no visitors are allowed due to covid outbreak in the hospital. The nurse said she had an episode during the night where she stood straight up and was rigid. They don’t think it was a seizure. She was lying in the bed with her eyes closed and was shaking. She didn’t even register I was there and just wasn’t like my mother at all. She was completely different today than when I last saw her. The ward sister I spoke to mentioned dementia but she had zero signs of dementia previously and was an extremely independent capable lady. I just can’t equate the person in hospital with my mother. This has been like a bolt of lightning. My mother was admitted to hospital in mid December due to fainting and this is when the discovery of growths on her lungs was discovered and cancer subsequently diagnosed. Between this and her worry about the surgery that took place she was fairly stressed but she was still herself. This waiting for brain mri is a killer because they won’t look at any other possibilities until they’ve ruled out a medical reason for it. The ward sister I met on Friday said she doesn’t think it’s delirium and mentioned dementia. On Friday night she spiked a temperature and is on IV antibiotics now fortunately. Urine sample has been sent off again and head ct repeated which was clear. Today she had to be fully assisted whilst having her breakfast. The change in her even since she’s been admitted is huge. She was able to feed herself no problem. Its awful.
I’m so sorry to hear about your mother’s experience, what an ordeal for her and your family.
You’re describing delirium very well, although everyone has a different course. It’s not unusual that the diagnosis of dementia gets raised when a person is in a delirium, but there’s a big difference. I made a YouTube video about that which you can watch here: https://youtu.be/uKp3sGwk4Tc
Remember that delirium can take a longer time than you’d expect to get better, even months, and in some cases, the person is not quite fully back to their previous baseline. I hope that in your mom’s case, she can make a full recovery, and I’m glad you can visit her. Those visits are likely to help her feel like her self again.
I have a family member that is in her mid 70’s. She is experiencing some delirium. But she understands that she sounds crazy to people that she tells about these episodes and doesn’t want help. When in the presence of a dr she comes across as very lucid. And claims the family member that was with her is abusive. The dr simply said to take her to the er, but she refuses to go. How can we help her?
I wonder if your family member is having delusional or paranoid thinking, rather than delirium? Hallucinations or delusions can be a part of dementia in older adults, as I discuss in this YouTube video:https://youtu.be/cjj6NyuPyCI, but can also be related to misperceptions of natural phenomena, distortions from impairments in hearing, vision or the sensory nerves, or part of a delirium.
This article about paranoia has some great information that I think would be helpful: https://betterhealthwhileaging.net/6-causes-paranoia-in-aging/
If these experiences are distressing to her, then an assessment by a medical provider is important, and if it is delirium, the cause needs to be uncovered and treated. Unfortunately, it sometimes takes a crisis or a dramatic change in the person’s situation to prompt them to seek help.
Thank you for the information and the time you take to answer questions! My mother in law is currently in a rehab facility in AZ (we live in PA) with a range of maladies: swollen hand that doesn’t work; inability to get out of bed (or walk), and complete incontinence. She’s also diabetic. After reading about delirium, I’m convinced she has a solid case of it. Her 48 year old daughter is with her now, but functions at a very low level mentally and can’t make rational decisions. That’s the background. My husband’s mom is mad at the facility she’s in and calls him daily ranting and raging and declaring that she’s going to go home. She has the 48 year old daughter telling everyone that there’s nothing wrong with her mom. Of course this seems utterly irrational, given my MIL’s inability to walk, use the bathroom, or remember basic words when trying to speak. We certainly feel for her and wish we could be helpful. (Going to AZ at this time is not an option.) If you have any insight, we’re all ears. Thank you so much.
The rages and rants you describe could be symptoms of delirium, especially if it’s a change from a previous pattern. It certainly sounds like there’s a lack of insight on your MIL’s part, which can be seen in dementia or delirium.
The staff at the facility may have experience with this type of response and are likely working with her to get her into a routine and back to as functional as she can be.
If your sister-in-law is sharing inaccurate information with other family, there’s not much you can do to counter it without expending a lot of energy and possibly stirring up conflict.
I would communicate with the care team at the facility and share your concerns about delirium. If you can have a conference with them, even better (this can probably be done virtually). Asking for a consultation from a geriatrician is a good idea too.
Should one agree with someone that has delirium when what they’re saying is absolutely wrong or change that subject .
Than
Someone who’s experiencing delirium can have hallucinations, delusions, and very disorganized thinking. Sometimes the person will insist that they see or believe something that doesn’t line up with reality.
In this case, I would advise not reorienting to reality, or doing so very gently. I would validate the person’s perspective (after all, it’s very real to them), and try to move on to more reassuring topics. You don’t need to go so far as to agree, but validation and reassurance are a good way to go.
I have seen similiar problems with elders accusing their otherwise dutiful wife of infidelity.
This ussually happens with Psychosis
You’re correct that delusions of infidelity are common, and can occur in delirium or dementia, among other conditions. There’s even a name for it: “Othello syndrome”, a reference to the character from Shakespeare. You can read more in this article: https://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2012.02386.x
Thank you so much for this article, which has been very helpful in understanding my 90 year old Mum’s situation. My Mum has experienced several episodes of delirium over the last 6 months and the underlying trigger has been infections, exacerbated by stress, anxiety and dehydration.
My Mum is currently better and much more clear headed. My question is whether she has any memories of the hallucinating thoughts she had while delirious?
I’m happy to hear that your mom is better now. Delirium can be very frightening and in my experience, many people who hallucinate or have delusions during an episode of delirium recall them and realize that their mind was playing tricks on them. Sometimes they will even be apologetic for their behaviour related to the hallucinations.
If they were disturbing to her, I would respond with reassurance and distraction. Hope she stays well!
Can a very low dose of lorazepam cause delirium in an elderly patient with vascular dementia? My mom lives at home and I’m trying to find safe ways to manage her agitation. Thanks!
Lorazepam is a benzodiazepine, and we usually try to avoid this type of medication in older adults, especially those with dementia. Dr K has an article about medications to avoid for brain health: https://betterhealthwhileaging.net/ags-beers-criteria-medications-older-adults-should-avoid-or-use-with-caution/
When it comes to an older adult with agitation, it can be helpful to try to figure out what there is in the environment or in the person’s health status that might be a trigger. Making changes to avoid the trigger can often be safer and more effective than use of a sedative.
Hi, my 85 year old father went into the hospital with what looked like a TIA or stroke because he seemed aphasia and had a hard time communicating. But stroke, all infections, meningitis and vitamin deficiencies have been ruled out. He does take some medications like ambien, Ativan, gabapentin and celexa in addition to warfarin and Harare medications for afib daily. The physician feels this must be a buildup of medications in his system but has labeled it acute delirium. Is this reversible? He is not able to speak much except for common phrase like “ how are you” and he answers yes no and “idon’t know. “. It’s been almost two weeks and not much change has been noted. He is not taking any medication except for his heart medications and melatonin. Can this be reversible and how long does it take?
I’m sorry to hear about your father’s difficulties. Unfortunately, delirium is common in older adults, and is always caused by some medical issue. Medications are quite often the culprit.
I made a video about delirium and it’s up on my YouTube channel: https://youtu.be/uKp3sGwk4Tc
Delirium can take days, weeks, or even longer to get completely better. Even after the offending medications are out of a person’s system, the delirium symptoms can persist. It’s frustrating for families and medical professionals alike.
Dr. K has an article on what you can do to prevent delirium, and these strategies can help a delirium to get better more a=quickly as well :https://betterhealthwhileaging.net/hospital-delirium-what-to-do/
I hope that in time your father is back to his old self.