Understanding delirium

Sudden changes in a patient’s thinking or behaviour can be caused by a medical condition known as delirium.

Delirium can cause changes including confusion, agitation or drowsiness can develop very suddenly and lasts from hours to a few days. Sometimes the changes may continue for weeks.

While delirium is more common in older adults, it can occur at any age and can be quite serious.

Up to 18 per cent of Australians aged 65 years or older have delirium during their hospital stay. It can affect more than half of cardiac, orthopaedic surgery and intensive care patients.

Who is at risk

Patients at risk of delirium include those who:

• are 65 years or older (45 years or older for Aboriginal people)
• are very unwell
• recently had surgery
• have a history of dementia or depression
• have reduced hearing and/or eyesight and do not use their aids or glasses
• take multiple medications.

Signs and symptoms

People with delirium may:

• appear confused, forgetful and have difficulty paying attention
• be very agitated and restless, or quiet, withdrawn and drowsy
• be unsure where they are or what day it is
• say things that do not make sense
• see things that are not there
• show personality and behavioural changes
• have changed sleeping habits
• display physical changes such as how they talk, walk or swallow
• lose control of their bladder or bowel.

Causes

Common causes of delirium include:

• infection
• multiple physical illnesses
• severe pain
• not drinking enough fluids (dehydration) or not getting adequate nutrition
• constipation or urine retention
• some medications, including ‘over the counter’ medicines
• withdrawal from medication, alcohol or other substances
• being in unfamiliar surroundings.

Treatment

Our staff thoroughly assess patients with delirium to identify and treat the cause where possible. Delirium is often linked to an existing illness or a combination of factors as listed above. Sometimes, however, it is not possible to identify its cause.

Treatments may include changing medications, treating an infection or treating an imbalance in the body.

Treatment then focuses on:

• managing symptoms
• reducing the risk of complications such as falls and pressure injuries (bed sores)
• environmental changes.

About the cognitive impairment identifier

The cognitive impairment identifier (pictured right) is placed near a patient’s bed to alert staff that a patient has memory and/or thinking difficulties, including delirium.

Even when meeting a patient for the first time, the cognitive impairment identifier reminds the treating team of that patient’s specific care and communication needs so they can better assist them during their hospital stay. The bedside alert also allows the treating team to involve the patient’s family and carers in their care as much as possible.

Read more about support for patients with cognitive impairment.

How you can help

If you are a patient

Tell your treating team if you are experiencing any new changes to your thinking or memory.

Family members or carers

If you notice sudden changes in the patient’s mental or physical condition, please speak with the treating team. If the patient has a pre-existing condition such as dementia, share information about their daily routine and how to comfort them if they are agitated.

Organising regular visitors is important as seeing familiar faces is reassuring for people with delirium.

The following tips can also help a person with delirium:

• Speak slowly and clearly and identify yourself and the person by name.
• Remind the person where they are, the time and day of the week. Knowing the time of day can reduce confusion.
• Visit in small groups of one or two people
• Encourage and assist the person to eat and drink. Ask staff about any restrictions before offering food other than hospital meals.
• Bring in personal items such as family pictures and their own clothes.
• Play the patient’s favourite music/radio stations (you may need headphones if the patient is in a shared room).
• Help the patient to wear their glasses or hearing aids if they use them.
• Talk calmly to the patient if they become agitated or aggressive and ask the staff for help.
• If the patient wants to walk around, walk with them in an open area free of trip hazards.
• Let nursing staff know when you’re about to leave the patient’s room.
• Carers are important – if you are a carer, remember to take care of yourself. Take regular breaks and don’t be afraid to ask for help.

Resources

• Aged Care Information Line – phone 1800 500 853
• Alzheimer’s WA (external site) or phone 1300 66 77 88
• Alzheimer’s WA Dementia Behaviour Management Advisory Service – phone 1800 699 799
• Caring for Cognitive Impairment (external site)
• Carers Australia WA (external site) or phone 1300 227 377
• Dementia Australia (external site) or phone 1800 100 500
• My Aged Care (external site) or phone 1800 200 422

Find out more

Read more about how we can work together to provide safe, quality patient care.