Delirium

What is delirium?

Delirium is a common condition which affects people with dementia. It affects people mentally and physically. It can affect people severely, and the person may be very confused. It is an acute condition, which means it can happen suddenly and may be serious. Delirium may develop over hours or days, and symptoms may come and go (fluctuate). Symptoms can be worse at night. Changes in behaviour are a sign that someone may have a delirium. These are listed below.

Delirium is often brought on by an infection such as a water (urine) or chest infection, changes in medication, or even dehydration and constipation. Older people and people with dementia are particularly affected and the risk of delirium increases as dementia progresses.

Delirium can be frightening for the person experiencing it, and also for those providing care. However, it can be prevented, and symptoms treated if dealt with promptly. Common symptoms of delirium are:

  • Being more confused than normal
  • Being unusually sleepy or agitated
  • Difficulty concentrating or becoming easily distracted
  • Being disorientated - not knowing where they are or what day it is
  • Being difficult to understand, with rambling or incoherent speech
  • Disturbed patterns of sleeping and waking
  • Mood swings
  • Hallucinations
  • Having unusual or paranoid beliefs

Comparing delirium with dementia may be a helpful way of working out whether someone living with dementia may have a delirium. However, you should speak to your GP or another healthcare professional if you think they may have a delirium to ensure prompt treatment.

Delirium Dementia
Comes on quickly Comes on gradually
Lasts for hours to weeks Progressive over months to years
Mental state fluctuates and is often worse at night Mental state is more stable: e.g. sundowning (usually distressed in the late afternoon/evening)
Attention decreased Usual attention span, alert or hyperalert
Language incoherent, slow or rapid Word finding difficulties

The PINCH ME method may be a helpful way to prevent, identify, treat and manage delirium. This method involves assessing all of the following to identify whether any issues arise which may result in delirium:

Pain

Infection

Nutrition

Constipation

Hydration

Medication

Environment

What can you do to help someone who may have a delirium?

  • Prevention – encourage the person to keep hydrated and be aware of changes in medication
  • Treatment – seek medical advice and support from your GP to identify the cause and provide treatment
  • Support – create a calm environment, remind the person where they are and give reassurance.

If the person is somewhere unfamiliar, such as hospital, bringing in personal objects (e.g. photographs) from home can help. Talk calmly to the person in short, clear sentences to help them to understand why they may feel different from usual.

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This article is from the free online course:

Dementia Care: Living Well as Dementia Progresses

Newcastle University