What to Expect After Delirium in Someone With Dementia

What can you expect in terms of recovery after your loved one with dementia has a bout of delirium? People with dementia often develop delirium (a state of worse-than-usual mental confusion) during the stress of an illness and when hospitalized.

Here's what to know next and what you can do about it:

1. After delirium: Know that it can take a long time to recover back to the old normal.

In principle, delirium is a reversible state of mental confusion. In people with dementia, however, it can take days, or even weeks, to return to predelirium mental abilities, even once the delirium triggers have been removed or treated.

What you can do

• First, be patient. Although you may hear of others who bounced back quickly after delirium, you can't hurry recovery. Enlist added support for yourself to weather this period, which can make caregiving more taxing, such as hiring an in-home caregiver to help or having relatives spell you more often.

• Provide supportive care. You can help your loved one recuperate by keeping his or her environment calm and consistent. Minimize visitors, including young family members who may not be remembered and may only add stress or confusion. Try to employ a small number of familiar in-home caregivers rather than a big, rotating cast of characters. Don't take your loved one out socially until things are stable. The least stressful setup now is a familiar home (or a hospital or facility room containing familiar objects) with a minimum of noise and fuss.

• Encourage your loved one to move around. "Resting comfortably and calmly" doesn't mean confining him or her to bed. In fact, constant bed rest can make things worse in someone who's able to walk or move about. So do allow for mobilization, but under supervision. Support your loved one when he or she walks or changes position.

• Keep an eye out for worsening mental state. The nature of delirium is to wax and wane, but the trend should be stable or improving. If you notice that confusion or other signs of delirium are worsening, or returning after an absence of time, don't hesitate to bring them to a doctor's attention. It's possible your loved one may have delirium again from a new cause, such as a medication side effect or a urinary tract infection.

2. After delirium: Realize that some people never recover to their previous mental abilities.

As is true of dementia in general, there's a lot of variability in how an individual may change after an episode of delirium.

Given enough time, and the removal of delirium triggers or their treatment, many people with dementia recover to what was normal for them before the delirium. Unfortunately, this isn't true for everyone. In some, mental decline accelerates after a bad episode of delirium.

What you can do

*Be optimistic but realistic. If it's been a while since the delirium has been treated, and your loved one with dementia has stopped improving, you may need to accept that there's a new, more impaired, normal. Of course, it can be hard to say whether the delirium created the decline or whether you're seeing the expected decelerating course of dementia. In either case, it's more productive to now focus on dealing with the new reality than beating yourself up with "if only's."