Delirium

Delirium is caused by:

• infections, especially, of the bladder (UTI), chest or skin
• medication, especially if several types are being used
• surgery or serious injury, including broken bones
• heavy alcohol use or withdrawal
• strokes
• diabetes that is not well controlled
• heart, kidney or liver failure
• dehydration, lack of sleep or constipation
• unrelieved pain or stress.

LHSC WDAD2019 Q2 What causes delirium

(iDelirium, 2019)

Sudden and new symptoms of:

• not being aware of the correct time and place
• poor concentration and short-term memory
• a disturbed sleep-wake cycle, including sleeping in the day
• hallucinations (seeing or hearing things that aren’t there) or delusions (false beliefs)
• being upset, confused or anxious
• being withdrawn and drowsy
• an unsteady walk or a tremor
• loss of bowel or bladder control.

How is delirium diagnosed?

Your doctor will want to find out the underlying cause of your delirium, so will ask about your symptoms and your medical history, as well as do a physical examination and blood tests.

How is delirium treated?                

If you have mild symptoms you will receive treatment at home for the underlying cause of the delirium. If you have severe delirium, you may be admitted to hospital and receive medication.

What are the consequences of having delirium?

(iDelirium, 2019)

The following may help you or someone you are caring for with delirium:

• reminders of the time or day, such as clocks and calendars
• making sure hearing aids and glasses are nearby
• moderate light, noise and temperature levels
• plenty of rest and no over-stimulation
• enough sleep, healthy food, water, movement and regular use of the toilet.

The PINCHES ME Kindly(external link) approach can be useful to help avoid delirium in elderly and sick people:

• Pain: manage
• Infection avoid
• Nutrition: good
• Constipation: avoid
• Hydration: plenty
• Exercise: appropriate
• Sleep: regular
• Medication: only as necessary
• Environment: quiet, sight and hearing aids

'Kindly' refers to the need to be supportive and compassionate.

Image credit : Think Delirium prevention project – PINCHES ME kindly(external link)  Canterbury District Health Board, NZ

For videos about delirium, visit iDelirium(external link) 
(external link)Delirium in older adults(external link)(external link) Health in Ageing, US
Delirium (acute confusion) – information for patients, families and friends(external link)(external link) Carers NZ

Preventing delirium while in hospital [PDF, 836 KB] South Island Alliance, NZ, 2019
Ideas for older people to help prevent delirium [PDF, 669 KB] South Island Alliance, NZ, 2019
Understanding and preventing delirium in older people [PDF, 1.6 MB] South Island Alliance, 2019
THINKdelirium(external link)(external link) Canterbury District Health Board, 2016
Delirium information for patients(external link)(external link) Waitematā DHB, NZ, 2019
Prevention, detection, assessment & management of delirium(external link)(external link) Waikato DHB, NZ

Related topics

Ageing – what is normal and when to seek medical advice
Dementia | Mate korongenge
Fever
Urinary tract infection (UTI) in women (Pokenga pūaha mimi)

References

1. Holden J, Jayathissa S, Young G. Delirium among elderly general medical patients in a NZ hospital(external link)(external link) Internal Medicine Journal. 2008. 38(8):629-634.
2. Young J, Inouye SK. Delirium in older people(external link)(external link) BMJ (Clinical research ed.). 2007. 334(7598):842-846.

Consultation

Delirium is easily misdiagnosed, so don’t assume confusion is due to long-term dementia or intellectual handicap even in the elderly and those with learning difficulties. It’s important to do a differential diagnosis between delirium, dementia and depression

• Confirm diagnosis using 4AT assessment test for delirium and cognitive impairment(external link) 4AT.com
• Surgery and anaesthesia should be avoided in very old people(external link) if possible because of the risk of causing delirium.
• For further information for health practitioners, see Delirium(external link) on patient.info.

Clinical resources

Delirium – te mate kuawa(external link) Health Quality & Safety Commission, NZ, 2019
Capacity assessment – te aromatawai āheinga(external link) Health Quality & Safety Commission, NZ, 2019
Delirium aware – a toolkit to facilitate quality improvement for hospital teams working with older people South Island Alliance, NZ, 2019
Delirium aware – a toolkit to facilitate quality improvement for aged residential care facilities South Island Alliance, NZ, 2019
Range of videos and health professional resources(external link) Australasian Delirium Association
Delirium balloon analogy – why is delirium more common in older people Delirium Care Network
Kids get delirium too – what to know about delirium in kids Delirium Care Network
Delirium guide for healthcare administrators Delirium Care Network