15252 Delirium

Overview

Delirium is a sudden change in a person's mental state, making them feel confused, disoriented, and unable to focus. It usually comes on quickly—over hours or a few days—and can come and go. Delirium is a medical emergency because it often signals a serious underlying health problem that needs treatment right away.

Yes, delirium is common, especially among older adults in hospital or care settings. It affects about 1 in 3 older people admitted to hospital.

Delirium most often affects older adults, particularly those with memory problems or serious illness. It can also affect children and younger adults, especially after surgery, severe infection, or a head injury.

Symptoms

Common symptoms

• Sudden confusion or saying things that do not make sense
• Trouble paying attention or staying focused
• Feeling disoriented about time, place, or who people are
• Memory problems, especially with short-term memory
• Seeing or hearing things that are not there (hallucinations)
• Rapid mood changes, such as fear, anger, sadness, or excitement
• Sleep problems—feeling very drowsy or being restless at night
• Becoming withdrawn and quiet, or agitated and restless

Symptoms in children

• Unusual irritability or being very hard to comfort
• Not recognizing family members or caregivers
• Acting fearful or clinging for no clear reason
• Being extremely drowsy or difficult to wake
• Poor eye contact and lack of attention

Symptoms in older adults

• New confusion that comes and goes
• Being unusually quiet and withdrawn, or agitated and restless
• Difficulty following a conversation or knowing where they are
• Acting 'not like themselves' with sudden changes in behavior
• Trouble focusing on everyday tasks

Causes

Main causes

• Infections, such as a urinary tract infection or pneumonia
• Dehydration or poor nutrition
• Changes to medications, including starting, stopping, or mixing them
• Low oxygen levels from heart or lung problems
• Severe pain
• Recent surgery, especially in older adults
• Head injury or concussion
• Chemical imbalances in the body, such as low sodium, high calcium, or low blood sugar
• Constipation or trouble urinating
• Lack of sleep or too much noise and unfamiliar surroundings

Risk factors

• Being over 65 years old
• Having dementia or mild memory problems
• Having had delirium before
• Being in a hospital or intensive care unit
• Having a serious illness or several health conditions
• Vision or hearing loss
• Taking medicines that affect the brain, such as sedatives or sleeping pills
• Having surgery, especially emergency surgery
• Being frail or unable to move around easily

When to see a doctor

See a doctor urgently if:

• If you see a sudden change in a person's attention or awareness, call your local emergency number right away. Delirium can be life-threatening if the cause is serious, like stroke, infection, or low oxygen.
• If the person cannot be woken, is having a seizure, or shows stroke signs, get emergency help now.

Book a routine appointment if:

• If the confusion is mild and not getting worse, contact the person's healthcare provider within 24 hours for advice.
• If the person is recovering from a known illness and you are unsure whether the confusion is expected, check with a doctor.

Diagnosis

A doctor will do a full medical check-up. They will ask questions, watch how the person responds, and may talk with family or caregivers to learn when the confusion started and what may have triggered it. The doctor will also look for physical signs of infection, injury, or other medical problems.

Tests that may be done

• Blood tests to check for infection, electrolyte problems, blood sugar, and organ function
• Urine test to check for a urinary tract infection
• Checks of blood oxygen levels and breathing
• Chest X-ray if a lung infection is suspected
• Electrocardiogram (ECG) to check the heart
• CT or MRI scan of the brain if a head injury or stroke is possible
• Sometimes a spinal tap (lumbar puncture) if infection of the brain is suspected

What to expect at your appointment

The doctor will examine the person and may ask for a detailed history from family members. It may take time to pin down the cause, but treatment often starts while tests are still being done. You can help by staying calm and giving the care team a clear timeline of when the confusion began.

Treatment

The most important treatment is to find and fix the underlying cause. This may involve antibiotics for an infection, fluids for dehydration, adjusting medications, or correcting chemical imbalances. In addition, the care team works to keep the person safe, calm, and oriented by making the environment comfortable and providing clear, reassuring communication.

Self-care at home

• Keep the room quiet, calm, and well-lit.
• Place familiar objects and family photos within sight.
• Remind the person where they are and what is happening each time you speak.
• Use short, simple sentences in a soft and friendly tone.
• Make sure they wear glasses or hearing aids if needed.
• Encourage a regular day–night routine with light during the day and dim light at night.
• Do not argue about confused statements—gently change the subject instead.
• Help them stay active with simple activities or short walks if safe.

Medical treatments

Treatment is always tailored to the person's needs. In some cases, doctors may use medicines to manage severe agitation or distress, but only when non-drug approaches have not helped and under careful supervision. Any medicine is given in the lowest effective dose for the shortest time possible. There is no standard drug to cure delirium itself; curing the cause is the goal.

When is surgery considered?

Delirium itself is not treated with surgery. However, the underlying cause—such as a broken hip—may require surgery. When possible, the care team will delay non-emergency surgery or adjust the plan to reduce the risk of delirium during recovery.

Living with this condition

Recovery from delirium can take days, weeks, or even months. Keep a consistent routine and a calm, predictable environment. Be patient, gentle, and reassuring. Help the person stay hydrated, eat regular meals, and move around as much as safely possible.

Lifestyle tips

• Stick to regular sleep and wake times.
• Drink enough fluids and eat nutritious meals.
• Encourage gentle movement and time out of bed during the day.
• Limit caffeine and alcohol, as these can worsen confusion.
• Keep the home environment quiet and familiar.
• Stay socially connected, but avoid too much noise or activity at once.

Diet and exercise

A balanced diet with fruits, vegetables, lean protein, and whole grains helps recovery. If the person has a poor appetite, offer small, frequent meals and favorite foods. Simple stretching, sitting up, and short walks can preserve strength and prevent muscle loss. Check with a physical therapist or doctor before starting new exercises.

Mental health and emotional wellbeing

Delirium can be scary and leave the person feeling anxious or embarrassed. Family members also often feel stressed and frightened. It is important to talk about these feelings and seek support. If sadness or worry lingers after recovery, ask a doctor about speaking with a mental health professional.

Prevention

Not all cases can be prevented, but many can. In hospitals, avoiding unnecessary medicines, removing bladder catheters early, encouraging sleep, keeping the person hydrated and mobile, and providing orientation aids (like clocks and calendars) all reduce the risk. At home, maintaining routines, good lighting, and regular contact also help.

Vaccines

Staying up to date with recommended vaccines, such as flu and pneumonia vaccines, may help prevent some infections that can lead to delirium. No vaccine prevents delirium itself.

Screening programmes

There is no routine screening test for everyone, but older adults who are admitted to hospital or having surgery may have their mental state checked with short questions. If you notice memory or attention changes, tell the care team early.

Complications

If left untreated

• Falls and injuries from confusion or agitation
• Longer hospital stays and slower recovery
• Loss of independence and ability to do daily tasks
• Permanent damage to thinking skills, especially in people with dementia
• In severe cases, a higher risk of death if the underlying cause is serious

Long-term outlook

The outlook for delirium is often good if the cause is found and treated quickly. Many people recover fully and return to their previous level of thinking and function. A calm, supportive environment and early help make a big difference in recovery.

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