A Discussion About Delirium

Physicians describe delirium as a medical condition that causes a patient’s mental status to shift back and forth (sometimes explained as “waxing and waning”). Caregivers often think of it as when their family member seems “not themselves,” either in the hospital or after they come home. Sometimes a family member who is seriously ill seems upset, agitated, combative or even psychotic. They may see things that aren’t there or mumble in ways you can’t understand. They may try to climb out of bed or want to walk without assistance, despite being very weak. Other times a family member may seem sluggish, confused or very sleepy. They may not respond to you, or may fall asleep in the middle of a sentence. All of these behaviors can be signs of delirium.

The term “sundowning” is often used in place of delirium, due to the fact that many of these changes take place in the evening and at night. Delirium is different from dementia, which is a slow progression of loss of memory and overall function. However, patients with dementia have an increased risk of developing delirium.

Delirium is still not completely understood, but scientists are finding that it is associated with an imbalance of chemicals in the brain, often related to an underlying medical problem in the body. One of the most common causes is infection. Something as simple as a bladder infection (sometimes called a urinary tract infection) or pneumonia can result in delirium. Other causes include certain medications, disturbances in electrolytes or other chemicals in the blood and failure of the kidneys or liver (both of which help remove waste and toxins from the body). In older people delirium can also be brought on by things such as severe constipation, heart attack, stroke or just simply being in the hospital or in an intensive care unit. A change in a patient’s mental status may be due to a combination of these and other problems.

It is important to remember that you know your family member better than anyone else. You may notice a slight change in behavior, speech or personality that the doctors and nurses do not see. Tell the doctor caring for your loved one about your concerns, so that the medical team can begin to look for the causes of these changes. Delirium is a serious medical condition.

Special tests may be needed to find the cause of your loved one’s delirium so that the medical team can come up with a plan to try to fix the problem. Studies have shown, however, that even if the original cause of delirium is corrected, it may still take weeks or months for your family member to get back to “normal.” Unfortunately, in some cases, patients never fully recover. This is particularly true in older patients or those with chronic or serious illness.

Delirium can be very frightening to caregivers. In some cases a patient may not recognize their caregiver, may not respond or may even be hurtful. It is important to remember that delirium is a medical condition and your loved one can’t control these behaviors. You can help your loved one just by being with them. Your familiar face in a sea of doctors and nurses can be reassuring to a patient and help them remain calm. Surrounding your loved one with pictures or familiar objects may also help improve their mental status. In some hospitals, large clocks or calendars are placed in patients’ rooms to help enhance their sense of orientation. So while delirium can be upsetting to patients and families, there are practical things that you can do to help improve the situation.