Delirium is a clinical syndrome involving an acute change in mental state typically involving variable attention, memory, and thinking. Delirium is a common and serious syndrome. It is a risk factor for increased hospitalization days, care cost, dementia, and mortality. Delirium can occur at any age, but is mostly identified among older individuals.
Up to 60% of hospitalized seniors experience delirium at some point during hospitalization. However, delirium is preventable in 30-50% of cases. For these reasons, identifying delirium risk and presence as well as caring for delirium is vitally important.
Delirium Versus Dementia
Delirium is different from dementia.
- Delirium comes on quickly, in hours or days.
- Signs of delirium can change from one day to the next.
- Delirium can make memory and thinking problems worse.
- Delirium is usually reversible, often lasts days to weeks, but may last longer.
- Dementia is usually a non-reversible condition.
- Dementia is the loss of cognitive functioning — thinking, remembering and reasoning — and behavioral abilities to such an extent that it interferes with a person’s daily life and activities.
- Dementia is a disturbance of thinking. It develops slowly over months or even years.
- Patients with dementia are more likely to develop delirium.
Risk Factors for Delirium
Experts think delirium is caused by a change in the way the brain is working.
This can be caused by:
- Low oxygen levels
- Chemical changes in the brain
- Severe pain
- Sleep disturbances
- Dehydration causing electrolyte abnormalities
- Prolonged immobility
- Urinary retention
- High-risk medications, including sedatives and pain medications
- Withdrawal from medications and substances (i.e. alcohol, cocaine)
Signs of Delirium
- Appearing agitated or aggressive
- Increased fatigue
- Increased time sleeping
- Using inappropriate words
- Not following directions
- Limited attention span
- Emotional changes
How to Help a Patient with Delirium
- Avoid confrontation
- Gentle reorientation if needed
- Maintain day/night orientation — lights on during the day, limit daytime naps
- Keep daily board information updated/visible
- Offer a snack
- Speak softly and use simple words or phrases
- Talk about family and friends
- Bring glasses, hearing aids, dentures
- Decorate the room with calendars, posters or family pictures. These familiar items might be reminders of home
- Provide the patient with favorite music or TV shows. If your loved one has delirium, we might ask you to sit and help calm them
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders, (DSM-5): American Psychiatric Publishers; 2013. Oh ES, Fong TG, Hshieh TT, Inouye SK.
- Delirium in Older Persons: Advances in Diagnosis and Treatment. Jama. 2017;318(12):1161-74. Inouye SK, Bogardus ST, Jr., Charpentier PA, Leo-Summers L, Acampora D, Holford TR, et al.
- A multicomponent intervention to prevent delirium in hospitalized older patients. The New England journal of medicine. 1999;340(9):669-76. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49(5):516-22.