Delirium (Acute Confusion)
Delirium is common in older people.
Delirium has the following
sudden onset and fluctuating course
altered level of consciousness
Delirium and dementia are similar,
There are many causes of delirium.
is a medical emergency.
- Delirium is quite common in older adults,
affecting nearly one-third of those admitted to hospital.
- Sometimes delirium accompanies a physical
illness like pneumonia or a stroke. Other times, it is the first
warning of a developing health problem.
- Regardless of its cause, delirium is a
serious medical condition – early recognition and treatment is
Delirium has the following features:
- Acute onset and fluctuations –
Confusion usually develops suddenly and progresses over the next few
hours or days. The confusion fluctuates with periods of agitation
and restlessness followed by periods of tiredness and indifference.
- Impaired attention – The person
has difficulty concentrating on familiar tasks, is not able to
follow simple commands, or becomes more and more forgetful. They
may not know what day it is, where they are, or even who they are.
Thinking is confused. Speech may be slurred or jumbled.
- Disorganized thinking – Unusual
suspicions, paranoia, or hallucinations may occur.
- Changes in
level of consciousness
- In hyperactive delirium, the person is
agitated, with mood swings, at times angry, belligerent, and
aggressive towards caregivers. For example, after surgery, they may
try to climb out of bed, yell at caregivers, or pull out catheters
and IV lines.
- In hypoactive delirium, there is extreme
drowsiness, fatigue, and indifference. As delirium fluctuates, the
episodes of lethargy are followed by periods of agitation and
hallucinations as in hyperactive state.
Delirium duration may range from a short episode
to a few days (and even a few weeks or months), depending on the
with the following characteristics are the most likely to have
- advanced age
- cognitive impairment or dementia (older
people with dementia are especially susceptible to delirium)
- history of previous episodes of delirium
- multiple medical conditions
- multiple medications
- severe stress (from events like a move to a
new environment, recent surgery or recent injury)
Dementia and delirium share some common
features and it is important to tell them apart. Dementia is a
constant, slowly progressing loss of memory and function. On the
other hand, delirium develops quickly. It is a warning of a serious
underlying medical condition.
Differences Between Dementia and Delirium
Onset and course
slow onset over months or years
sudden onset over hours or days
inattentive, easily distracted
gradual memory loss
more forgetful than usual
normal or depressed
anxious, fearful, suspicious, indifferent
sign of illness or drug side effect
Many medical conditions and other problems can
lead to delirium. Remember this helpful hint – the letters in
the word "DELIRIUM" stand for the common reasons for this
many medications, recently started or stopped,
changes in dosages, over-the-counter medications, herbals, alcohol
especially from dehydration
Lack of drugs
stopping certain medications, alcohol
such as urinary or respiratory tract
infections; blood or wound infection after an injury or surgery
such as poor or uncorrected vision and hearing
such as from a stroke
Urinary or fecal
such as inability to empty bladder or bowel
heart attack, pneumonia, or other condition
causing lack of oxygen in the blood and the brain
Early detection and treatment is essential
because delirium is a sign of a serious underlying medical condition.
In addition, older people with delirium are susceptible to injuries,
falls, dehydration, pressure sores, and malnutrition.
is a medical emergency. Accompany your family member to the emergency
department, and be ready to provide information on:
- past medical problems
- current medication list
- details of everyday functioning and thinking
before the confusion
content of each Caregiver College Topic may be linked to a
variety of other Topic areas, the following has been identified as a
Key Linkage which you may be interested in also reviewing:
- Information for Patients and Families –
Delirium: This PDF document from Capital Health's Regional
Specilized Geriatrics Program provides information about the causes
and treatment of delirium. It also describes how family members can
help with treatment and communicate with both a confused older
person and a health care provider.
Manuals: Merck Manuals provides information about
delirium, including its causes, symptoms, treatment and diagnosis.
It also contains tables to assist you in comparing delirium with
dementia and psychosis.
HealthMap – Delirium: This flowchart
facilitates easy access to detailed information on diseases,
condition progression, therapeutic options and outcomes. The
information is organized by topic and is contained in the Merck
Manual Home Edition.
Mental Health Association
- A brief article on dementia versus delirium.
- Canadian Mental Health Association website
page titled Seniors and Delirium. Information specific to
seniors and delirium is presented.