Delirium

Delirium is a sudden change in the way a person thinks or acts. It is this rapid onset of confusion and difficulty in paying attention that makes delirium different from depression and dementia.

Delirium can occur due to a number of different causes such as injury or infection, medicine, surgery, a change in environment, and/or not getting enough water or other fluids.

In a hospital or care setting, you should report to staff if you notice that someone is not acting the way they usually do. Regular visits from loved ones and helping the person keep a routine similar to home as possible will minimize the risk of delirium. Bringing familiar items from home during a hospital stay, such as a favourite blanket or pictures, may also help.

A major change in the person's behaviour that makes you feel that "this is not the same person that I know". The person may become fearful and anxious when they are delirious. These feelings may cause them to become agitated or to try to "get away". They may have good and bad times. Sudden changes in behaviour indicate it is delirium, not dementia or depression.

You might see some of the following behaviours in the person, where they may:

• Not know the time or where they are
• Report that they are ill and in hospital; however, they still want to leave to continue with their regular daily activities (e.g. go to work)
• Be drowsy or sleepy during the day and awake and restless during the night
• Be agitated and restless or may be less active than usual
• See things that are not there (hallucinations)
• Not be able to make sense out of the sounds and voices around them
• Say things that may embarrass you, like swearing or yelling
• Hit, pinch or do other things they would not normally do

There are many things that can make delirium worse or last longer. Some of these things are:

• A change in environment such as leaving their home to go to hospital
• Surgery
• An infection
• Not get enough water or other fluids
• Medicine
• Alcohol or drug use
• Not enough oxygen to the brain
• Hit their head

The doctors, nurses, and other staff will:

• Quickly identify and look for the possible cause(s)
• Start treatment quickly, e.g. medicine for infection, give water and other fluids, give oxygen
• Assess the person’s mental state and behaviour
• Try to follow the person’s home routine and activities as much as possible
• Reduce environmental stimuli

• You know the person the best. Please tell the staff if you see any unusual behaviours.
• Be supportive of the person and consistently tell them this will pass.
• Visit as regularly as possible. Your presence can reduce fear and anxiety.
• Bring familiar articles from home such as favourite music, pictures and blanket.
• Ensure that prescription glasses, hearing aid and dentures are in good repair and used.
• Work with the staff to establish a regular and a consistent routine.

Fraser Health supports a least restraint policy. We do not restrain a person (including bed rails and chair belts) unless all other alternatives have been unsuccessful to assure safety and then only after consultation with staff, physicians and family.

Speak with your doctor or health care team if you have any other questions regarding delirium.

The following resources provide more information on delirium:

• Fact sheet: Delirium in the older adult – A family guide
• Island Health: Delirium in the older person
• Canadian Coalition for Seniors’ Mental Health