Can Delirium Be Prevented?

10 answers | Last updated: Feb 07, 2015
A fellow caregiver asked...

Can delirium be prevented?

Expert Answers

Dr. Leslie Kernisan is a senior medical editor at and a clinical instructor in the University of California, San Francisco, Division of Geriatrics. She also provides housecalls and geriatric consultations in San Francisco.

Yes, studies have shown that it's sometimes possible to prevent delirium, especially in those people who are most at risk of developing it (the elderly and those with dementias such as Alzheimer's). Experts estimate that 30 to 40 percent of delirium that occurs in the hospital may be preventable.

These seemingly minor actions have proven useful in preventing delirium in large hospitals:

  • Making sure patients are given their eyeglasses and hearing aids

  • Providing clocks as well as extra reminders and explanations to improve orientation ("You are in the hospital, you've had hip surgery, today is Monday, and the month is June.")

  • Getting patients out of bed and walking as soon as possible (being forced to stay in bed can tip some people into delirium)

  • Promoting sleep by minimizing noise, blood draws, and blood pressure checks at night and in the early morning, rather than using sleeping pills (Obviously a patient or caregiver can't control these factors, but you can ask why sleep meds are needed and whether they can be avoided through measures like these.)

  • Avoiding dehydration by encouraging the person to sip water and other fluids, rather than relying on intravenous hydration

Another study found that for elders hospitalized after hip surgery, the involvement of a geriatric consultation team (a team specializing in optimizing the care of older adults) substantially reduced delirium. Among other things, the geriatric team focused on pain management, bowel and bladder function, nutrition, and reducing medications that can affect the brain.

Unfortunately, no medication has been found to reliably help prevent delirium.

Delirium is most easily prevented when an elder's hospital care is provided by trained staff, such as those in Acute Care for Elders (ACE) units, geriatric consultation teams, or even specially trained volunteers. Not all hospitals provide these specialized services, however. Fortunately, family members and concerned caregivers can always be helpful in providing a sick elder with glasses, hearing aids, and a reassuring and familiar presence. Caregivers are often among the first ones to notice if a loved one is developing delirium in the hospital; bringing the condition to the doctor's attention is extremely important.

Community Answers

Sboland@allanbrosfru answered...

Hi Leslie, My aunt is 90, she lives with my husband and I, and hopefully will be able to until the good Lord takes her. Her delirum is getting worse, she is hallucinating every night. I just checked her urine and it shows only a very tiny trace of infection. When it is like this it won't even show at the doctors test.
They had her on Seraquel 25 mg and it doesn't help and I think it actually makes it worse. She told me this morning that she doesn't know how much more she can take, I'm not sure how to help her anymore other than be there for her, but of course she just wants to argue about what she is seeing. Help :) She is fine during the day, but her eyes are bad so of course at night it all gets worse, when I turn the big light on it helps. Well I better get back to work, thanks for listening Stephanie :)

Rboverman answered...

My Dad is in a nursing home and it seems that everyone is given Seraquel 25 mg.... He got worse after getting this medication and we requested that he not be given this any longer. He is somewhat better, and I believe if you check the side effects of Seraquel 25 mg that you will be disturbed what it shows. I hope you find answers to your problem.

Sboland@allanbrosfru answered...

thanks I did read the side affects and only gave her one at first, then after a month or so, and she couldn't sleep I finally started giving them to her, then she decided she didn't want to take them anymore, so we went probably 2 months without and now it's getting unbarable for her again. thanks for listening :)

A fellow caregiver answered...

Seroquel is usually given for behavior issues. Especially if the resident is very agitated and combative. Where I work we have started using Klonopin for anxiety that starts at sundown. With a low dose at 4pm and a tablet at bedtime. It comes in chewable tabs. As the expert said stay in the routine. Make sure they have what they need and that they aren't upset because they are in pain and cannot say. Any change in routine will cause some degree of delirium.

Ca-claire answered...

A little over a year ago, my Dad had to have a stent put into his carotid artery. A fairly routine procedure, but since Dad was 87 at the time, the interventional cardiologist arranged for him to spend the night, once his procedure was done in the early AM. Oh my, who knew that I would have to spend 20 hours a day at the hospital for the next 4 days. The hospital psychosis got so bad someone had to be at this side 24/7. My sister was 18 months post open heart surgery, but she and her husband came thinking it would only be for a couple days. We ended up having to call our 2 brothers to get them to come help. I took the 8pm to 8am shift, since I had the most experience with caregiving and was the closest kid to Dad, but then the siblings wanted me there when the Dr's came by (unscheduled, of course), so I spent 5 days with very little sleep. The brother that arrived 3 days post op, called me and woke me up after spending about 2 hours with him. He couldn't handle it - he works with special needs elementary/Jr. High kids as a teacher.

Then we had to move them up near me, was already planned for the future, but we had to just do it. Two weeks later they were up in my city, and are finally settled in. I hope never to see this type of psychosis ever again. Parts of it were funny to watch - my brother called it puppy sleep (he was doing movements and you could tell what he was doing - trying to clean a cupboard door or find a lost pill in his lap during motions where he was filling one of those weekly pill bins), but some of it broke your heart.

None of the medication seemed to help him, and now he is different - the procedure which saved him from a serious stroke probably tipped him much further into dementia.

Best wishes to all that have to work with dementia-affected family members.

Sboland@allanbrosfru answered...

Hi everyone, Just thought I would give you an update on my Aunt Mary, I took her to the doc again about 3 weeks ago, and he put her on Trazadone, she has NOT had a halucination since the 1st pill, I give it to her everynight about 8:30 with a treat, doctors orders :) and she sleeps like a baby usually within an hour, only has had a couple restless nights, but no visitors in her mind. So far so good, WHEW !! I'm so happy for her. Her sleep patterns are great now, up and at it in the morning and to bed earlier. Thank you Lord. Stephanie :)

Tootsie @ 60 answered...

My 83 year old mother has been experiencing delirium off and on for almost a year. It was absolutely unavoidable in the hospital, as I could not be there with her 24/7. But coming back home has helped immensely. I have found to agree with everything she says, but do what I must anyway. Unless someone draws it to her attention, she doesn't even realize my action taken. It is key, to keep her from getting aggitated or upset about anything - as it just escalates into full blown delirium. We have replaced her car keys with ones that will not work in the ignition. She has not mentioned it, earlier if we even hinted about her not driving, it would set her off. Once the delirium set in, her dementia would also get worse. So we avoid the delirium at all costs.
I hope this is helpful to those of you coping with a loved one with dementia. God Bless you all!

Art4kelly answered...

My Mom is 70 and Tootsie's Mom sounds like mine. My Mom lives in a mobilhome park and she has a few neighbors that seem to set off her delirium. It makes for a very difficult day when this happens. I would love to get her out of this place as soon as possible. I have tried to explain to them that things they say to her just make her condition worse but they continue to do it. They too are older people so it may be that they just don't remember either.

Tootsie @ 60 answered...

Mom had another bout with delirium this past week. We have established that - any time she is not in complete control of a situation, it aggrevates her to the point of is unavoidable, but now that we know to look for it, we can deal much easier. Agreeing or sympathizing with her does help in defusing her. God Bless you all!