Delirium is a sudden and severe change in brain function that can make a person seem confused or disoriented. It’s often triggered by a serious illness, by certain medications, drug withdrawal or intoxication. The risk of developing delirium is highest in people over the age of 65, especially if that person is living with dementia.
While some people may become agitated, others may simply appear confused. Delirium can also occur in any care setting — hospitals and nursing facilities, or at home. Additionally, elders (and those living with dementia) aren’t the only high-risk individuals. Those with underlying brain diseases like stroke or Parkinson’s are also at high risk.
Some additional high-risk factors:
- Using multiple medications
- Multiple medical problems
- Sudden withdrawal of regular medication
- Cessation of chronic alcohol use
- Malnutrition
- Immobility
- Undertreated pain
- Poor eyesight or hearing
- Sleep deprivation
Delirium is distinct from dementia because it occurs suddenly, within hours to days, rather than gradually over months or years. Unlike dementia, delirium is typically temporary and resolves when the underlying cause is addressed. The primary goal of treatment is to identify and address the cause of delirium while ensuring the person’s safety.
Approximately 30 percent of older patients experience delirium during hospitalization, with an even higher incidence in intensive care units. Regardless of the setting, cognitive and behavioral changes may be subtle — such as difficulty maintaining focus, shifting topics frequently in conversations, expressing bizarre ideas, struggling to retain simple information or experiencing disorientation in time or place. Visual hallucinations can also occur. It’s also important to note that symptoms tend to worsen intermittently — particularly in the afternoon and evening. This can sometimes help distinguish delirium from dementia.
Recognizing delirium can otherwise be challenging, as behavioral changes may be mistakenly attributed to age, preexisting dementia or other mental disorders. Symptoms may also fluctuate throughout the day, with few or no symptoms in the morning but increasing as the day progresses. When delirium is suspected, prompt medical evaluation is critical to diagnose the underlying cause and initiate treatment, as some life-threatening conditions can induce delirium.
The evaluating clinician should gather the patient’s complete medical history and current medications. Diagnostic tests may include blood and urine tests, a chest x-ray to rule out pneumonia, brain imaging (CT or MRI scan), lumbar puncture to check for infection and EEG to measure brain activity. Treatment for delirium itself does not exist; rather, treatment focuses on a few fundamental principles:
- Avoiding factors that trigger or aggravate the delirium
- Identifying and treating the underlying cause
- Providing supportive and restorative care
- Controlling dangerous behaviors to avoid harm to the patient or others
For the first episode of delirium, initial treatment typically occurs in a hospital setting. This allows healthcare providers to monitor the patient, address the underlying issue and establish a long-term supportive care plan with the patient and their family. The aim of supportive care is to maintain the patient’s health, prevent complications, and avoid factors that worsen delirium. With elders, delirium often leads to prolonged hospital stays and decreased ability to function independently. While some cases may resolve within hours or days, others may take weeks or months to improve.
Dr Liz has over 20 years of experience as a geriatrician. She is board-certified in internal medicine, geriatric medicine, and palliative care medicine. Dr Liz founded Dr Liz Geriatrics to address the challenging medical and behavioral issues often facing older patients and their families.