Delirium

Delirium can be caused by:

• infections – especially of the bladder or kidneys (called a urinary tract infection or UTI), chest or skin
• medicines – especially for pain, anxiety or sleep
• surgery or serious injury, including broken bones
• heavy alcohol use or withdrawal
• strokes
• diabetes that's not well controlled
• heart, kidney or liver failure
• dehydration, lack of sleep or constipation
• unrelieved pain or stress.

Sudden and new symptoms of:

• not being aware of the correct time and place
• poor concentration, confusion, or trouble remembering recent things
• a disturbed sleep-wake cycle, including sleeping in the day and being awake at night
• hallucinations (seeing or hearing things that aren’t there) or delusions (false beliefs)
• being unusually upset, anxious, angry or suspicious without good reason
• being withdrawn and drowsy.

Diagnosis

Your healthcare provider will want to find out the underlying cause of your delirium, so will ask you, your friends or loved ones about your symptoms and your medical history. They will also do a physical examination and blood tests.

Treatment                

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 medicines.

Video: What are the consequences of having delirium?

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(iDelirium, 2019)

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

• reminders of the time or day, eg, clocks and calendars
• making sure to use hearing aids and glasses 
• comfortable amounts of light, noise and heat or cold
• plenty of rest and moderate amounts of activity – don't overdo it!
• enough sleep, healthy food, water, movement and regular use of the toilet.

Image credit: Canva

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

• Pain – manage with the help of your healthcare provider. Read more about pain.
• Infection – avoid by going to the toilet regularly, checking your skin for redness or irritated areas, telling your healthcare provider about any fevers (high temperatures).
• Nutrition – eat plenty of good food. Read more about healthy eating.
• Constipation – avoid by going to the toilet regularly, and talking to your healthcare provider if you're not opening your bowels (passing poo) as usual. Read more about constipation.
• Hydration – drink plenty of water.
• Exercise – do appropriate amounts of exercise but don't overdo it.
• Sleep – regular sleep is important. Talk to your healthcare provider if you're not sleeping well. Read some sleep tips.
• Medication – only as necessary. Talk to your healthcare provider occasionally to see if there are any medicines you no longer need. Read more about medicine reviews. 
• Environment – calm and quiet is better that noisy or busy. Keep glasses and hearing aids nearby and use them when needed.  

'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