If you care for an older adult, it’s important to know about delirium. This condition is marked by sudden changes in a person’s ability to pay attention or respond coherently, and it requires immediate attention.
“Delirium is an acute medical emergency,” says UNC Health pulmonologist and geriatrician C. Adrian Austin, MD. “It’s a sign that something is severely awry in the brain and body, and it’s paramount to identify the cause so it can be addressed.”
Delirium can happen to anyone, but it’s most common in adults 65 and older. Dr. Austin explains symptoms to know and possible causes.
Recognizing Delirium
Delirium can be difficult to identify because it can look different for each person.
“The symptoms are typically on a spectrum,” Dr. Austin says. “Someone might be really sleepy and lethargic, or hypoactive (less active than normal), or they might seem psychotic or hyperactive. The hyperactive symptoms are easier to recognize—they might be aggressive or violent—but that’s less common.”
When someone is not moving or eating much, it’s natural to assume that they just don’t feel well, Dr. Austin says. But if they don’t interact with you when spoken to and this is a change, that’s a red flag.
Even if they are speaking with you, a person with delirium will not be able to pay attention or focus on you for very long, and their replies may not make sense based on what you said.
“People with delirium can’t pay attention and might seem like they’re spacing out,” Dr. Austin says.
Delirium has many other possible symptoms, including confusion, memory issues, problems speaking or understanding speech, and mood or personality changes. The severity of symptoms can fluctuate over the course of minutes, so that someone who was incoherent 10 minutes ago now seems completely fine.
Delirium and Dementia
Many of these symptoms might seem like dementia, and dementia is a risk factor for delirium; a person can have both.
“Dementia is chronic and prolonged, while delirium is an acute change in how people are thinking, so changes happen suddenly, within hours or days,” Dr. Austin says.
If you care for a loved one with dementia, you’re probably familiar with their baseline, or what a good day or bad day looks like for them. But anything that seems new or uncharacteristic, whether the person has dementia or not, is a sign that the person needs attention.
While both dementia and delirium can have symptoms related to memory, symptoms from delirium should come on acutely and be new, and there should also be some difficulty paying attention or maintaining focus.
“It’s about not being able to focus long enough to say the days of the week backwards, rather than not being able to remember what day it is or where they are currently,” Dr. Austin says.
Causes of Delirium
Delirium can be caused by medications, infections and disturbances in the body’s chemical balances, such as changes in sodium or calcium levels (which may be caused by medications and infections).
“With older adults, recent changes to their medicine or an infection are the most common causes,” Dr. Austin says. “Pneumonia, urinary infections and wound infections are the most common, but it could be any infection.”
Prescription medications, including benzodiazepines and some blood pressure medications, can cause delirium, but it’s important to be mindful about over-the-counter drugs as well.
“Diphenhydramine, or Benadryl, can make people quite delirious, and that’s the active ingredient in a lot of nighttime and allergy drugs,” Dr. Austin says.
Strokes, heart failure, alcohol or drug use, withdrawal from alcohol or drugs, lack of sleep and exposure to some toxins can also cause delirium.
Surgery or hospitalization are risk factors for older adults; as many as half of people who have a high-risk surgery, such as cardiac surgery, have delirium after, and a third of people age 70 and older in the hospital experience delirium.
Because there are so many distinct causes, what’s actually happening in the brain and body of one person with delirium differs from another, but permanent damage to the brain is possible. That’s why it’s so important to identify the cause and start treatment as soon as possible.
Treating and Preventing Delirium
If you’re concerned your loved one is experiencing delirium, seek care right away. You can check to see if their primary care provider is available to see them that day, because receiving care in a familiar surrounding can be helpful. If you can’t get in quickly, go to urgent care or the emergency department and ensure that you or another familiar person stays with them.
“Having a loved one around is really important, because in an unfamiliar setting like the hospital, people with delirium can become quite fearful,” Dr. Austin says. “That support person can reassure them. They can do other helpful things such as encourage the person to wear their glasses and hearing aids, which can help them interpret the environment.”
The treatment for delirium will depend on the underlying cause—an infection may be treated with antibiotics; an electrolyte imbalance could improve with intravenous fluids. Medications may be stopped or adjusted.
While delirium starts quickly, it typically has a slower resolution.
“People with delirium are often having periods of abnormal behavior and periods of clarity, and as delirium resolves, the periods of clarity increase and the periods of delirium decrease,” Dr. Austin says. “Sometimes it resolves in a few days; sometimes it takes weeks. But even after recovery, the majority of people have cognitive deficits for the long-term,” from brain fog to dementia.
Older adults will likely need additional assistance in the home after a bout of delirium, or they may have to move into a skilled nursing facility.
“The long-term impacts can make it difficult for someone to take care of themselves, so they may need help bathing or managing their medications,” Dr. Austin says. “They may need to be reminded to eat or drink water.”
Because these long-term impacts are profound, it’s important to adopt healthy lifestyle habits that can help to prevent delirium.
“Older adults should stay physically active, avoid smoking and see their doctor regularly to attend to medical issues,” Dr. Austin says. “Be careful about any medication you take. Know the ingredients in medications, and when you’re prescribed a new one, ask if there’s any chance that it could affect your mind.”
For more information on healthy aging, talk to your doctor. If you need a doctor, find one near you.