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Delirium

Baylor Scott & White Supportive and Palliative Care

What is Delirium?

Delirium is very common in patients with advanced illnesses. With delirium, patients have periods where they are suddenly confused and unaware of what is going on around them. They may become agitated and restless or withdrawn. Delirium can be very upsetting for family members to witness. If your loved one develops signs of delirium, let his or her physician know right away. In some cases, the cause of the delirium can be treated; in others, steps can be takin to help manage delirium and ensure your loved one's safety​ and comfort.

What are Common Causes of Delirium?

Delirium often has multiple cases; these can include:​

  • Infections
  • Medications
  • Serious or terminal illness
  • Hospitalization
  • Changes in environment
  • Drug and alcohol abuse
  • Electrolyte imbalance
  • Other problems, like anemia or nutrition deficiency

What are the Types and Symptoms of Delirium? 

There are two mains types​ of delirium: hypoactive and hyperactive. Patients can have one or both types. In hypoactive state, patients​ are sleepy and withdrawn; they may show little interest in their surroundings. In a hyperactive state, patients are excitable and agitated; they may become violent and may believe in or see things that aren't there. Most patients with delirium will also have the following symptoms:​

  • Changes in sleep patterns
  • Confusion about time and place
  • Wandering attention
  • Disorganized thinking
  • Problems with memory and speech
  • Changes in mood or personality
  • Hallucinations

How is Delirium Treated?

Your loved one's physician will try to identify the cause of the​ delirium and treat it, if possible. Sometimes the cause cannot be found, or treatment may be available, but it may be too much of a burden at this point in their illness. In such cases, the main goal of treatment is to manage the delirium and keep you loved one safe and comfortable. Your physician may tell you to do the following:​

  • ​​Provide safe and familiar surroundings, and keep your loved one's room clean and well-lit. Have familiar objects nearby, like a favorite blanket and family photos. Add a clock next to the patient's bed and a calendar on the well to help your loved one keep track of the time.
  • Limit contact with strangers. Try to make sure that your loved one receives care from the same healthcare providers or caregivers. Keep visitors restricted to family members or close friends to reduce confusion.
  • Maintain a regular day and night schedule. During the day, open blinds and windows or keep the lights on to encourage your loved one to stay awake and alert. During the night, dim the lights and keep noise levels low to encourage sleep.
  • Expect changes in behavior. There may be times when your loved one is normal and alert, but other times he or she is not fully present. Your loved one may forget who are you. He or she may also imagine things or speak to people who aren't there. Try to stay calm during these episodes; it may help to provide a gentle touch or reassuring words, or you may choose not to speak and simply listen.
  • Use positive language, try not to raise your voice or argue​​ with your loved one, and keep conversation simple. If your loved one is confused, state simple and calmly where he or she is and what is going on.
  • Minimize the use of restraints and encourage movement as soon as possible. These can make a person more anxious, afraid, or angry and increase confusion. If needed, arrange for a 24-hour caregiver or nurse, so your loved one is never left alone, or take turns sitting next to the patient's bedside with other family members and friends.
  • Alert the physician is your loved one's delirium worsens. If needed, medicine can be prescribed to help your loved one sleep or stay calm.
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