Delirium

What is delirium?

Delirium is a severe state of confusion that includes rapid changes in your level of consciousness. Delirium may develop in a matter of hours or over the course of several days. Times of confusion come and go.

Stupor is a word used when there is confusion and inability to stay awake (to stay fully alert and conscious).

How does it occur?

Experts think delirium is caused by a change in the way the brain is working. Something:

• decreases the supply of oxygen to the brain
• affects the use of oxygen by the brain or
• changes the chemicals in the brain.

People with dementia (a permanent state in which the mind no longer works normally) tend to have delirium.

Although poor vision and hearing do not cause delirium, people who do not hear or see well are more likely to develop delirium. This is especially true when they are in surroundings that are strange to them.

Medicines are the most common cause of delirium. Older adults may be taking several different drugs, high doses of drugs, or drugs that are harmful when taken together. Also, as you get older, your body does not process drugs as well as it used to. As a result, drugs can stay too long in the body and cause toxicity (poisoning).

Many medicines can cause or contribute to delirium, especially drugs used to treat:

• pain
• mental health problems, such as depression
• stomach ulcers
• heart problems.

Even cold medicines sometimes cause confusion.

Medical illness can lead to delirium. Common causes include conditions that:

• decrease the brain's oxygen supply
• lower blood pressure
• change body chemistry
• cause low or high blood sugar.

Infections in the lungs and bladder or kidneys are common causes. Delirium is less often caused by a physical change in the brain, such as can result from a stroke or tumor.

Pain can contribute to delirium.

Alcohol use and withdrawal can cause delirium. Delirium tremens (DTs) is probably the best known form of this condition. DTs can happen to a long-time heavy drinker who suddenly stops drinking. He or she may have tremors, seizures, and hallucinations (seeing or hearing things that are not there).

People who have a heavy drinking habit may be afraid to stop drinking because they fear having DTs. These people should see their healthcare provider. There are several ways to stop and keep from having DTs.

Delirium can also result from mental factors such as:

• depression
• grief
• lack of sleep
• loneliness
• too much or too little stimulation.

These conditions are very common among people who are in the hospital, especially if they are in the critical care unit (CCU) or intensive care unit (ICU). There may be no windows and no day and night routines in the ICU to help keep patients oriented.

Delirium is a serious problem for older adults in the hospital. For many frail older adults, just having surgery is a risk factor for delirium. Delirium is also common following a move into a nursing facility.

What are the symptoms?

Symptoms of delirium may include:

• agitation alternating with times of increased drowsiness
• mood swings (depression and fear are common)
• memory problems
• trouble concentrating
• trouble following directions
• sleep problems, including not being able to sleep at night and being sleepy during the day
• hallucinations (seeing or hearing things that are not there), sometimes with delusions (false beliefs)
• rambling speech
• disorientation (not knowing the time, date, where you are, or who you are).

How is it diagnosed?

To find the cause of delirium, your healthcare provider will:

• ask about medical history, including medicines being taken
• do a physical exam
• order blood and urine tests.

Your provider may also order X-rays or special scans.

How is it treated?

Delirium is an emergency. Keep calm and try to protect someone who is delirious from harm. If you cannot reach your healthcare provider right away, get emergency medical care. The causes must be found and treated. Even with proper treatment, delirium may not go away quickly. Sometimes people need to stay in the hospital where they can be watched closely until the confusion has cleared.

Treatment may include:

• help with personal care and meals for a time
• supportive care and, when needed, medicine for agitation and unruly behavior
• calm and quiet surroundings without background noise from TVs, radios, or distant conversation
• support from family, friends, doctors, and nurses to help calm the person and help the person to get his or her bearings
• glasses or hearing aids to lessen the feeling of isolation if the person has poor hearing or eyesight.

Physical restraints should be used with great caution. They may make the person more upset and can lead to falls and injuries. Very rarely, restraints may be needed to prevent the person from removing an IV or tube. When possible, a family member or friend can sit with the person so that restraints will not be needed.