What is Delirium?
Delirium is a common problem for many people with a serious illness. People can become confused, find it hard to think clearly and may behave very differently from what is usual for them.
These changes start suddenly, usually over days or hours and can change from hour to hour.
Delirium is different from dementia because it comes on suddenly and not over months and years. And unlike dementia, people can sometimes get better if the problems causing the delirium can be treated. When someone is very unwell or nearing the end of their life however, this may not be possible.
Delirium is very common in people in the last days of life and can be a sign that someone’s condition is worsening. The treatment then is to keep them safe and comfortable.
Delirium can be very frightening for the person as well for their loved ones around them.
People with delirium may not remember much of the illness if they get better.
If you think that someone you know may have a delirium, or have noticed any changes
that you are worried about, please let your doctor or nurse know.
What does delirium look like?
A person with delirium may:
- Have trouble concentrating, for example following a conversation
- Not be aware of where they are
- Not recognise close or family friends
- Not notice what is going on around them
- Become more active; fidgety, wandering, agitated or become aggressive
- Become less active; be more sleepy, quiet or withdrawn
- Be more awake at night and sleepy in the day time
- Hallucinate – see or hear things that are not there
- Not be able to do something as well as before (for example, eating or walking)
- Become paranoid – believe things that aren’t true, for example that others are trying to harm them
What does it feel like to have delirium?
You may:
- Not notice what is going on around you
- Be unsure about where you are or what you are doing there
- Be unable to follow a conversation or to speak clearly
- Be very agitated or restless, unable to sit still and wander around
- Be very slow or sleepy
- Sleep during the day, but wake up at night
- Have moods that change quickly – you can feel frightened, anxious, depressed or irritable
- Have vivid dreams – these can be frightening and may carry on when you wake up
- Worry that other people are trying to harm you
- Hear noises or voices when there is nothing or no one to cause them
- See people or things that aren’t there
Who is more likely to get delirium?
Anyone can get delirium but it is more common when someone:
- Is older
- Has memory problems already
- Has poor hearing or eye sight
- Has had delirium before
- Has a serious illness that is getting worse, for example, cancer or heart failure
- Is nearing the last days of life
What can cause delirium?
Delirium is usually the reaction of the brain to a medical problem. Usually there is more than one problem which can make it harder to treat. It may not be possible to treat some causes of delirium.
Common problems that can cause delirium include:
- A urine or chest infection
- Constipation
- Not being able to pass urine (urinary retention)
- Liver or kidney problems
- Advanced cancer
- Brain injury or infection
- Dehydration, low salt levels, high calcium levels
- Low levels of oxygen getting to the brain
- Side effects of medicines like pain killers and steroids
- Uncontrolled pain
- Suddenly stopping alcohol or some regular medications
- Being in an unfamiliar place
How can I help someone with delirium?
- Stay calm
- Talk to them in short, simple sentences
- Repeat things if necessary
- Explain what’s happening to them and reassure them that they’re safe and are being cared for
- People with delirium can easily misinterpret words and actions and say hurtful things. Try to not get upset when this happens but reassure them you will take their concerns seriously
- If they say things that do not make sense, try to avoid confronting them. Try gently distracting them onto a different subject
- Try playing music they’re familiar with
- Try to avoid having lots of visitors to avoid crowding or overstimulating the person with loud chatter
- Remind them of the time and date. A clock can be helpful for some people
- Make sure they have their glasses and hearing aid
- Help them to eat and drink
- Try to make sure that someone they know well is with them – this is often most important during the evening, when confusion often gets worse
- Bring in some familiar things from home, such as photographs or a favourite blanket
Have a light on at night so that they can see where they are if they wake up
How do you look after someone with delirium?
The first thing we will look for is what might be causing someone’s delirium. If it is possible, we will try to treat these problems to help them get better from the delirium.
But for many of the patients we care for, it may not be possible to reverse the delirium.
This is because they often have lots of medical problems from their serious illnesses that cannot be treated or cured.
When this happens, the delirium is usually a sign that things are changing in a way that we cannot control and that someone might be approaching the end of their life.
If this is the case, our main aim is someone’s comfort and dignity and we will try to manage the symptoms of their delirium as much as possible to help keep them safe and comfortable.
If you have any questions or wish to discuss a loved one’s care further, then please do not hesitate to raise this with your nurse or doctor. We are here to support you.
We are always pleased to hear any comments about the services we are providing.
Your feedback helps us to maintain a high standard of service and we are really keen to hear from you. You can also complete our feedback survey via our website.
Please visit: www.farleighhospice.org/feedback