FAQ: Can Delirium Symptoms Be Treated With Medications?

6 answers | Last updated: Oct 20, 2016
A fellow caregiver asked...

Can delirium symptoms be treated with medications?

Expert Answers

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

Yes, delirium symptoms can sometimes (but not always) be treated with medications. For such symptoms of delirium as extra confusion, agitation, or aggression, low doses of antipsychotics may be prescribed. These drugs, such as haloperidol (Haldol), risperidone (Risperdal), and quetiapine (Seroquel), can help settle down a wildly paranoid person with delirium and dementia.

However, they should be used as a last resort and only for a short time, since these drugs increase the risk of falls and can have other side effects. Research studies have also found that using antipsychotics in people with dementia raises the risk of death and stroke.

Tranquilizers such as lorazepam (Ativan) and diazepam (Valium) should be avoided in older people with dementia and delirium, because they tend to worsen confusion and/or cause too much sedation. Unfortunately, these drugs are still sometimes used by doctors, especially those who have not received geriatric training.

Medications to manage delirium symptoms should never be a substitute for identifying and reversing the underlying cause of delirium.

The reassuring presence of familiar caregivers is always the safer, and often more effective, way to manage delirium symptoms.

Community Answers

Frena answered...

a wildly paranoid person, surely, is a person with serious mental illness, NOT a person with dementia? in over 20 years of working as a caregiver with people with dementia, the only ones i've seen who have "wildly paranoid" behaviors were elders who were actually mentally ill and whose families were shielding them from diagnosis and treatment, sometimes in ignorance and sometimes deliberately.

i dont think it helps to throw all this stuff in with dementia, as if none of the differences mattered. and i don't think this expert pays nearly enough attention to the appalling abuse of elders in care who have been routinely given anti-psychotics that killed them.

more needs to be said about the many reports coming in from Europe, from Canada and all over the USA to highlight the shame and unprofessionalism that has allowed our elders to be abused in the name of medical care. death rate is increased by 33 percent when elders with dementia are given anti-psychotics, instead of being looked after by people who know how NOT to scare those they care for.

of course giving a frightened elder with dementia an anti-psychotic quiets them down -- so would a 2x4 round the side of the head, but that's illegal. so should the use of anti-psychotics on elders who are not psychotic be illegal.

Kunzite52 answered...

When my dad became violent we admitted him to a mental facility and found the drugs he was on had the reverse effect on him. They were changed in the facility as changing meds can bring on other symptoms altogether. Yes, my father did become paranoid and in fact would not even take his meds. He became delusional, wanting to help people who he was sure existed, but surely did not. I coaxed him carefully into the car and told him we would go help. We went to the hospital, at which point I had a complete meltdown. Seeing this dad realized he was in a hospital and suddenly, with lucidity, asked if he needed to stay there. If "I" needed him to stay there. At that point he agreed. He has been on a few drugs, but mostly if they were changed it was done in a professional facility. Now when he gets paranoid I give him the rispiradone and he is fine. You say these drugs should not be administered to dementia patients? I disagree. I am able to shower my dad every evening, and would not be able to do so without the medication. Furthermore after many many sleepless nights, I had to find something to address his stenosis (severe back pain) and confusion at night that kept him awake. We also did this with medications, not pain meds, not narcotics! Not sleeping meds either, rather trazadone worked to help him sleep. I have cared for dad for nearly 4 years at home. He can never be left alone, ever. I schedule his week with activities every day, and be sure he is engaged most all the time. He knows who his family is, who we are, his two children and grandchildren and he knows the dog. I am fairly sure that if he was in a home this would not be so. He wants to participate in the family and we all ask his advice all the time.
He was brilliant, my dad in his career and life. Some of that remains today, and certainly his distant past he recalls. Living with family we can help him recall much of it, and using pictures and stories we keep him in the loop of what is going on. I could not keep him home in a violent state or completely delusional state. So I use medication prescribed by his geriatric psychiatrist, and they work, and dad is happy at home, where he is loved, and he knows it.
I am not saying it is easy to keep your loved one at home. Some can be mean spirited in life and hence in dementia as well, but this is not true of my dad. When my dad dies, just as when my mom did, I will be able to state without doubt that I made the end of his life better. I will not live with guilt but genuine memories of our good times together. And sometimes if your loved one is angry, it helps to honestly tell them how that makes you feel, and then ask them what you can do to help, this might mean detaching yourself emotionally, taking a step back. But after all, they were adults when you needed them to be, now they need you to be the adult. Always, annie

A fellow caregiver answered...

I agree with Frena, medications given to the Elderly or AD disease should be considered abuse, when families are not told the dangers. Families trust the doctors and nurses but they do not really know your loved one or care about them like you do. They tell you how much it will help them and they know darn well it is a huge risk. They work with the drug companies and like the power and control. Shame!!! Been there. Hold your ground. They don't like it but to bad, it's not their loved one. I see it all the time I work at a facility where my parent is as well. I have had to come head to head with them many times, and I was right to refuse to let them drug my parent.. They are doing much better without the drugs. But I see other families putting their trust in everything the MD or nurse says and it is sad. Question it when in doubt, research it yourself online before trusting what they say. Vit D3, melatonin, fish oil are a couple alternatives for some issues they may have.

Kunzite52 answered...

"Vit D3, melatonin, fish oil are a couple alternatives for some issues they may have.". I use all of these and other homeopathic remedies for dad. Paranoia is indeed part of dementia and yes I can control it and talk him down most times, but not all the time. I do not abuse the use of these very powerful drugs. I have many doctors for dad from psychiatrists to geriatricians. I also have another group of doctors at the VA who watch over him and his medications. Dad is not mentally ill and never was, but then to see him horribly paranoid and afraid is not conducive to his good health either. I think there has to be some middle road, not all uses of anti psychotics in the elderly Alzheimer's patients is abusive. His doses are low and help him. I do not think we can blanket all anti psychotic drugs for the elderly as abusive. If he was in a nursing home he would be getting them as well, as per the psychiatrists there when he was temporarily there for rehab. As the disease has progressed the need for them has become less and not more. Every person is different. I always go with the homeopathic meds first. I am sorry if my opinion is different than yours and I respect your opinion. However, my dad has Parkinson's, Alzheimer's, arthritis and spinal stenosis. He is on no narcotics whatsoever for pain or sleep. He is happy with us, and for that I am eternally grateful we are able to keep him home as opposed to putting him in a home. It is a different view but it has validity, I am far from an abuser. I truly love my dad with all my heart. And so sorry about the difference of opinion here.

Dee42 answered...


Not sure when you wrote about your Dad but I hope you both are doing well. You should not have to explain to anyone about your Dad being on an anti-psychotic (when necessary). My mother in law is in a Memory Care facility after being asked to leave her Assisted Living facility because of violent outbursts and behaviors. We didn't care for the one we moved her to and moved her again after a week to the facility she is now in. She is fortunate to have long term care insurance since this facility if over $5,200/Month. She is now on Resperdol (sp?) because she was having frightening hallucinations and terrifying delusions. She has always been tested for UTI's to rule those out. We tried putting her on only two doses since we wanted to make sure she was on the lowest dose possible but that didn't work. At least we tried :/ We know the aides, nursing staff and administrators and visit often. Her other children have moved out of state. It has been a challenging two years since we moved her into Assisted Living/Memory Care - taking care of her home (cleaning it out and selling it) and going through ten years of paperwork that were not organized at all. We feel we have done our best finding this wonderful facility and visiting and keeping in touch with the staff. They know we are available 24/7 if she needs anything. She is still able to recognize us and walk outside and visit. She eats well and sleeps better now. We certainly didn't want her on anti-psychotics but we worked with the staff to find alternatives and other meds and nothing worked. She has been checked for UTI's so that wasn't the cause of the hallucinations, delusions. I feel you are doing a wonderful job taking care of your father and you should be commended..I know iit isn't easy. We should try to support each other and learn from other people's experiences. What works for one, may not work for another but I'm sure we are all trying to do the best we can for our loved ones.

Take Care,