Key points about delirium

  • Delirium is a confused mental state that causes disorientation (confusion). It starts suddenly and can come and go.
  • It is common in older people and people with other health conditions.
  • It usually has an underlying cause. Many people make a full recovery once this has been treated.
  • Risk factors include being over 65 years old, having dementia, a hip fracture or severe illness, and being elderly and in hospital.
  • Getting help early limits its longer-term effects.
Nurse smiles at older woman with walking stick

(Creative Connection, UK, 2016)

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  • being withdrawn and drowsy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.

Infographic describing ways to help avoud delirium in older people using the PINCHES me kindly approach

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


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


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


preventing delirium while in hospital

Preventing delirium while in hospital

South Island Alliance, NZ, 2019

ideas for older people to help prevent delirium

Ideas for older people to help prevent delirium

South Island Alliance, NZ, 2019

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