• Reference Number: HEY-861/2017
• Departments: Elderly Medicine
• Last Updated: 1 March 2017

Introduction

This leaflet has been produced by the Department of Medicine for the Elderly at Hull University Teaching Hospitals NHS Trust to give you general information about delirium.  If you have any other questions please do not hesitate to discuss this with a member of the healthcare team caring for you or your relative or friend.  This leaflet is not intended to replace any discussion with the medical team, but may act as a starting point for discussion.

What is delirium?

Delirium is a sudden change in mental state, which may be confusion, agitation, personality change, and difficulties with understanding and memory. It is also referred to as acute confusion. It is not the same as dementia, although people with dementia are at an increased risk of delirium.

What causes delirium?

Delirium has many causes. Often more than one thing causes it to develop. Some causes are:

• Pain
• Infection
• Constipation
• Hydration
• Medication
• Environment

How common is it?

About 1 in 10 people in hospital have a period of delirium. This may be more frequent in those who are older, have memory problems or dementia, have poor eyesight or hearing, have a terminal illness or have a medical condition affecting the brain, such as a stroke, head injury or infection.

A person with delirium may:

• Find it difficult to follow a conversation and may be easily distracted.
• Have vivid dreams or hallucinations, which may also be frightening and upsetting.
• Become agitated and paranoid and need a lot of reassurance.
• Become sleepy and slow, and may appear withdrawn.
• Be confused at some times more than others, especially at night.

Please notify a member of staff if you notice a change in your relative’s or friend’s behaviour.

How is delirium treated?

If someone becomes suddenly confused they need to see a doctor as soon as possible. The person may not understand what is happening, so it is helpful if someone who knows them can stay with them and give information to the medical and nursing teams.

If delirium is suspected tests will be carried out to look for possible causes. For example blood tests, urine tests, a heart tracing (ECG) and X-rays.

Treating the underlying cause treats the delirium. Very occasionally sedatives are used. Sedatives can make the confusion worse and should only be used in certain situations, such as:

• For an essential investigation or treatment to be carried out.
• To prevent harm but they will be used for as short a time as possible.

The Butterfly Scheme

In this hospital we use the Butterfly Scheme which is an opt-in scheme for people with dementia or delirium. It aims to help staff recognise patients that may be suffering with delirium to allow patients to receive more effective and appropriate care and so reducing their stress levels and increasing their safety and well-being.

Please ask a member of staff  if you would like more information, or if you or your relative would like to enter the scheme.

How long will it take to get better?

Once the cause gets treated it should start to get better. Everyone is different, some recover in hours, others in days or weeks. People with dementia or head injuries may take longer to get better.

Afterwards the person affected may not remember what has happened. Some remember the vivid dreams and hallucinations. It can be helpful to talk about what has happened with the medical or nursing staff.

Delirium can recur and so further episodes of confusion can be a warning sign of a further illness such as an infection. This should be treated as soon as possible.

If the delirium continues we may ask a member of the psychiatric team for advice.

How can relatives and friends help?

Whilst it can be frightening and upsetting for you to see your loved one confused and agitated it is important you stay calm.

• Reassure them
• Talk in short, simple sentences, checking you have been understood. You may need to repeat things. Talk about familiar topics.
• Gently remind them where they are, the date and time and why they are in hospital.
• Bring in their own calendar or a small clock.
• make sure they have their usual glasses and hearing aids and use them.
• If required, help them to eat and drink. Bring in favourite food /drinks if this helps.
• Bring in some familiar photos or objects from home.
• Visit in small groups, particularly in the evening – stimulating the person too much can make things worse.

Further information is available at:

• National Institute for Health and Care Excellence (NICE) information leaflet for people with delirium, carers and those at risk of delirium
• Royal College of Psychiatrists Information Leaflet