What is delirium?
Delirium is a state of mental confusion that starts suddenly and is caused by a physical condition of some sort. You don’t know where you are, what time it is, or what’s happening to you. It is also called an 'acute confusional state'.
What does delirium feel like?
It often starts suddenly and usually lifts when the condition causing it gets better. It can be frightening – not only for the person who is unwell, but also for those around him or her.
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.
What causes delirium?
Medical problems, surgery and medications can all cause delirium. Common causes include: a urine or chest infection, having a high temperature, malaria, dehydration, low salt levels, low haemoglobin (anaemia), suddenly stopping drugs or alcohol, major surgery, epilepsy, brain injury or infection, terminal illness, constipation, side-effects of medicine like pain killers and steroids, liver or kidney problems
How can I get help for delirium?
If someone becomes suddenly confused they need to see a doctor urgently. Once a physical cause has been identified, it needs to be treated. For example, a urine infection will be treated with antibiotics.
Simple steps can be taken to help them feel safer and less agitated. These include:
- explaining to the person what has happened, and why they feel confused
- reassuring them that they are safe
- helping them to know what time it is and where they are - a large clock and a written message about where they are can be helpful
- having familiar items from home around the bedside
- having friends and family visit
- making sure that someone has their glasses and hearing aids – and that they are working!
Medication
Some people become so distressed that medication may be needed to calm them down. Sedative medications may do this but, unfortunately, they also make the delirium worse so they should only be prescribed if the person:
- becomes a danger to themselves or other people
- is very agitated or anxious
- believes others are trying to harm them
- is seeing or hearing things that are not there – low doses of anti-psychotic medication can help
- needs calming down so that they can have important investigations or treatment
- is someone who usually drinks a lot of alcohol and has stopped suddenly – to stop them having fits, they will need a regular dose of a sedative medication (a benzodiazepine), reduced over several days under close medical and nursing supervision.
Any sedative medication should be given at the lowest possible dose, for the shortest possible time.
Tips for families, partners and carers
You can help them to feel calmer, and more in control, if you:
- stay calm
- talk to them in short, simple sentences and check that they have understood you
- repeat things if necessary
- remind them of what is happening and how they are doing
- remind them of the time and date – make sure they can see a clock or a calendar
- listen to them and reassure them
- 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
- if they are in hospital, bring in some familiar objects from home
- have a light on at night so that they can see where they are if they wake up