Patient Information - Delirium

What is delirium?

Delirium is a state of mental confusion that can happen if you become medically unwell. It affects about 2 in 10 hospital patients but is more common in older people, especially those who are on Intensive Care units or already have some decline in their thinking skills. It can be frightening - not only for the person who is unwell, but also for those around them.

What is it like to have delirium?

You may:

  • Be less aware of what is going on around you.
  • Be unsure of where you are or what you are doing there.
  • Have vivid, frightening dreams, which may continue when you wake up.
  • Hear noises or voices when there is nothing or no one there to cause them.
  • See people or things which aren’t there. n Worry that other people are trying to harm you.
  • Be very agitated or restless. n Be very slow or sleepy. n Sleep during the day, but wake up at night.
  • Be more confused at some times than others—often in the evening or at night.

Who is at risk of developing delirium?

  • Older people.
  • People with memory problems/ dementia.
  • People who have poor hearing or eyesight.
  • Severely ill people.
  • People who have had surgery.
  • People with an infection.
  • People who are dehydrated.
  • People who are terminally ill.
  • People who have suddenly stopped drugs or alcohol.
  • People taking certain medication such as painkillers and steroids.
  • People who have constipation.

How can I help someone with delirium?

  • Stay calm.
  • Listen to them and reassure them.
  • Talk to them in short, simple sentences.
  • Remind them of what is happening, where they are and of the time and date.
  • Try not to agree with any unusual or incorrect ideas, but tactfully disagree or change the subject. Do not contradict them directly.
  • Make sure they can see a clock or a calendar.
  • Make sure they have glasses or hearing aids that they normally use.
  • Help them to eat and drink. n Try to make sure someone they know well is with them. This is often most important during the evenings, when delirium often gets worse.
  • Bring in some familiar objects from home.
  • Have a light on at night so that they can see where they are when they wake up and what time it is.

How is delirium treated?

To treat delirium you need to treat the underlying cause of which there are many. Common causes include infection, dehydration, constipation and pain and each person may have more than one cause. For example, a urinary infection may be treated with antibiotics, encouragement to drink and eat and pain relief.

Bright lights and a quiet room are often helpful. Medication may be needed to reduce distress especially if the person with delirium is very agitated.

How long does it take to get better?

Once the cause is treated, delirium can take several days or weeks to resolve fully. It is important to see whether the person recovers more quickly at home before making important decisions about future care. Medical staff will let the GP know that someone has had delirium in their hospital discharge letter so that the GP can assess this at a later date and refer on to other services if further investigation is needed. It important that you know what has been said / sent to the GP so that you can ask for a review appointment with the GP.

Useful contacts

  • Ward staff should always be the first people you ask for more information. They can also arrange referral to the in-patient carer support services and Mental Health Liaison service.
  • Memory Café, Southmead Hospital, Gate 28, Wednesdays 2-4pm. A time and place where hospital and delirium specialists are available to talk with you about any concerns you may have with care over a cup of tea. Members of the Carer’s support team are also present to provide advice. All are welcome, just turn up.
  • Southmead Hospital Carer Liaison Team can be contacted directly on 07557 418 692.
  • Alzheimer’s Society National Help line 0300 222 1122.
  • Alzheimer’s Society local telephone number 0117 961 0693.
  • Alzheimer’s Society website:www.alzheimers.org.uk
  • Royal College of Psychiatrists (web based information on delirium): www.rcpsych.ac.uk/mental-health/problemsdisorders/delirium
  • Delirium prevention, diagnosis and management (National Institute for Health and Care Excellence): www.nice.org.uk/guidance/cg103/

Reference

In developing this leaflet for local use in North Bristol Trust, the Royal College of Psychiatrists delirium leaflet accessed at web address above was used as a basis.

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published May 2019. Review due May 2021. NBT003161