How Is Delirium Treated?

A fellow caregiver asked...

How is delirium treated?

Expert Answer

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

Treatment of delirium involves three overlapping steps:

  • Finding and treating any underlying new stress on the body, such as a urinary tract infection or other cause of delirium.

  • Providing supportive care to keep the person safe and to prevent loss of function during the period of delirium. This might include regular supervised trips to the bathroom ("timed toileting"), which can minimize incontinence; as well as carefully getting the person up and out of bed, in order to prevent pressure sores and to maintain strength. Preventing falls is also important, although, paradoxically, tying a person down for his or her safety (a common fall-prevention tactic) often makes the confusion of delirium worse. Much better: having an observer or family member stationed at the bedside to get help when the delirious person tries to climb out of bed or tries to pull out an IV.

  • Minimizing the confusion and difficult behavior associated with the delirium by providing a calm and reassuring environment. The presence of family members or other familiar people can be helpful. As with dementia care, calm and reassuring environments often work better than such medications as haloperidol (Haldol), which should be used only as a last resort. Sedatives such as alprazolam (Xanax) and diazepam (Valium) often make delirium worse in older people.

Although treating the cause of delirium often makes the person better in a matter of days, it can take weeks or even months to fully recover. People with dementia, who are especially prone to become delirious when sick, also generally take longer to get better. Unfortunately, many don't ever recover to their predelirium level of cognitive abilities, instead settling at a new, more confused normal. For this reason it's important to try to prevent delirium, especially when a person with dementia is hospitalized.