delirium

What is delirium?

Delirium is a medical condition that causes a loss of attention, a lack of awareness, and an inability to think clearly. There are rapid changes in the level of consciousness. Delirium may develop in a matter of hours or over several days. Symptoms may come and go. The key symptoms are disorientation and confusion. If a person is panicked, upset, and agitated but knows who they are, where they are, and what is going on around them, they do not have delirium.

Delirium is different from dementia. Dementia is a gradual loss of mental functions such as the ability to think, remember, reason, and plan. It is usually long-lasting and never gets better, while delirium usually goes away after a time.

People who have dementia sometimes have delirium as well. In this case, their confusion gets worse but may get better with treatment.

What is the cause?

Delirium appears to be caused by a change in the way the brain is working. Something:

  • decreases the supply of oxygen to the brain
  • affects the use of oxygen by the brain, or
  • changes the chemicals in the brain

Medicines are the most common cause of delirium, especially drugs used to treat:

  • pain
  • mental health problems, including anxiety and depression
  • stomach ulcers
  • heart problems

Even cold medicines can sometimes cause delirium.

Delirium caused by medicines can be a particular problem for older adults. They may be taking several different drugs, high doses of drugs, or drugs that are harmful when taken together. Also, as you get older, your body does not process drugs as well as it used to. As a result, drugs can stay too long in the body and be poisonous to the body.

Medical illness can lead to delirium. For example, it can be caused by:

  • infections in the lungs, bladder, or kidneys
  • a physical change in the brain, which can happen, for example, from a stroke or tumor
  • pain
  • drug abuse
  • mental illness
  • surgery

Alcohol use and withdrawal can cause delirium. Delirium tremens (DTs) is probably the best known form of this problem. DTs can happen to a long-time heavy drinker who suddenly stops drinking. He or she may have tremors, seizures, and hallucinations. (Hallucinations are seeing or hearing things that are not there).

Grief or a mental health problem, such as depression, can cause delirium. When mental illness, such as schizophrenia, causes delirium, it may be called psychosis rather than delirium. Both terms mean that someone has lost their view of present-day reality.

Delirium is very common in hospital patients. This is especially true for people in the critical care unit or intensive care unit (ICU). There may be no windows and no day and night routines to help keep patients oriented. For many frail older adults, just having surgery is a risk factor for delirium.

Delirium is also common in older adults after a move into a new environment.

What are the symptoms?

The key symptom of delirium is disorientation (not knowing the time, date, where you are, or who you are). Other symptoms may include:

  • agitation alternating with times of sleepiness
  • mood swings, including depression and fear
  • memory problems
  • trouble concentrating
  • trouble following directions
  • sleep problems, including not being able to sleep at night and being sleepy during the day
  • seeing or hearing things that are not there
  • rambling speech

Poor vision and hearing do not cause delirium, but someone who doesn’t hear or see well is more likely to get disoriented. This is especially true when they are in surroundings that are strange to them. If a confused person is aware of their surroundings but says that they don’t know where they are or how to get around, they may be disoriented but they do not have delirium. However, a disoriented person can panic and start having delirium.

How is it diagnosed?

The healthcare provider will talk to the person and look for disorientation and other symptoms.

To find the cause, the provider will:

  • Ask about medical history, including medicines being taken.
  • Check with family, friends and hospital staff to see if things said by the person are true or imagined.
  • Do a physical exam.
  • Order blood and urine tests.

X-rays or special scans may be done.

How is it treated?

Delirium is an emergency. Keep calm and try to protect someone who is delirious from harm. If you cannot reach your healthcare provider right away, get emergency medical care. The causes must be found and treated. Even with proper treatment, delirium may not go away quickly. Sometimes the person may need to stay at the hospital, where they can be watched closely until the confusion has gone away.

Treatment may include:

  • help with personal care and meals for a time
  • supportive care and, when needed, medicine for agitation and difficult behavior
  • calm and quiet surroundings without background noise from TVs, radios, or distant conversation
  • support from family, friends, doctors, and nurses to help calm the person and help the person get his or her bearings
  • glasses or hearing aids to lessen the feeling of isolation if the person has poor hearing or eyesight

Physical restraints should be used with great caution. They may make the person more upset and can lead to falls and injuries. Very rarely, restraints may be needed to prevent the person from removing an IV or tube. When possible, a family member or friend may sit with the person so that restraints are not needed

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