How to spot it and how you can help
Information for family, and friends of patients
This leaflet answers some frequently asked questions about delirium.
What is delirium?
Delirium is often preventable, and half of all delirium episodes are potentially reversible. It is therefore important to be aware of the signs and symptoms, to be able to spot delirium quickly and treat early
Delirium is an acute state of confusion. It presents itself with cognitive changes such as difficulty with attention and altered awareness. The onset can be sudden, and its presentation can vary greatly Delirium usually comes on fast — within hours or a few days.
Types of delirium
Delirium can be categorised into three different types which can present quite differently.
The person may fluctuate between types.
Hyperactive: with heightened arousal and behaviours such as restlessness, agitation, or aggression.
Hypoactive: the person becomes withdrawn, quiet and drowsy This can be more challenging to diagnose.
Mixed: the person demonstrates both hyperactive and hypoactive features.
diagnoses that can be mistaken for delirium are dementia, depression and psychosis. The person may also have dementia, delirium or both.
Common
Can delirium be treated?
Delirium can be managed using non-pharmacologic supportive care and pharmacologic strategies (treatment for reversible causes of delirium and emotional and behavioural distress)
What can cause delirium?
Delirium can often be traced to one or more factors. Factors may include a severe or long illness or a chemical imbalance in the body (for example low sodium) The condition also may be caused by certain medicines, infection, surgery, or alcohol/drug use or withdrawal.
Common causes of Delirium (think DELIRIUM)
Drugs (toxicity, interactions, withdrawal) / Dehydration
Electrolyte imbalance (eg: high calcium; high or low sodium)
Level of pain
Infection/Inflammation
Respiratory failure (eg: low levels of oxygen, high levels of carbon dioxide)
Impaction of faeces
Urinary retention
Metabolic disorder (eg: liver/renal failure; high or low blood sugar levels)
What are the signs and symptoms of delirium?
The person is likely to display disorientation in time, place and may have a slow reaction time with either increased or decreased flow of speech and altered social behaviour They may also have
a disturbed sleep-wake cycle with their symptoms being worse at nightime They may have disturbed dreams and nightmares which may continue as hallucinations or illusions after awakening. Delirium affects a person’s ability to communicate, make decisions and function and is associated with poor quality of life and increased mortality. It can be upsetting for families of those affected, especially if the person becomes agitated or aggressive
What can I do to help someone with delirium?
Do’s:
Orientate the person frequently: letting them know who and where they are and whom you are
Use calm speech and a gentle manner.
Be courteous and polite, even if the person isn’t
Acknowledge their feelings and show concern.
Provide easily accessible clocks and calendars, good lighting and signs.
Use familiar pictures/items around the bed.
Try to maintain a consistent routine and care.
Use cognitively stimulating activities such as reminiscing.
Use relaxing and/or familiar sounds/music and smells (e g. Lavender, spices, flowers)
Optimise any sensory deficit with items such as hearing aids, glasses etc.
Use soft massage in the palm of the hand to induce feelings of comfort and safety
Hydrate person by offering drinks.
Promote good sleeping habits. Encourage meaningful day time activity to help keep awake during the day
Reduce loud noises and bright lights at night
Consider spiritual support.
Support the person to continue walking/ getting out of bed if they are safe to do so
Be patient, giving the person time and space
If needed and safe, leave the room for 5-10 minutes and retry again.
Don’ts:
Don’t insist on performing unnecessary tasks such as washing/dressing/shaving etc.
Don’t argue and avoid commands, reasoning is usually impaired in delirium.
Don’t frequently change carers or the person’s location or routine
Don’t physically restrain the person. If safe mobilise the person with regular breaks such as trips to the toilet.
Caring for someone? Did you know Trinity has a carers’ clinic – a space just for carers to discuss challenges or needs they have. Contact your Trinity Community Nurse, Palliative Care Assistant, Healthcare Assistant or Doctor for a referral.
How to contact Trinity
Royal Trinity Hospice
30 Clapham Common North Side
London SW4 0RN
Call 020 7787 1000
Email enquiries@royaltrinityhospice.london
www.royaltrinityhospice.london
@trinityhospice
RoyalTrinityHospice
@royaltrinityhospice
If you would like this information in a different format, such as large print, or to be translated, please speak to the Communications team on 020 7787 1000 or email media@royaltrinityhospice.london
Royal Trinity Hospice will always store your personal details securely
For full details see our privacy policy: www.royaltrinityhospice.london/privacy
Charity no. 1013945
Date of publication June 2023
