What Is Delirium, and What Causes It?

18 answers | Last updated: Nov 03, 2017
A fellow caregiver asked...

What is delirium, and what causes it?

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.

Delirium is a state of acute mental confusion, meaning a person's state of mind suddenly becomes worse than usual. Delirium can cause a person with a perfectly healthy mind to behave like a person who has dementia. For persons with dementia, delirium makes their mental state worse. The key is that it's a sudden change from what's normal for that individual.

The main signs of delirium usually include:

  • Confused thinking.

  • Difficulty focusing.

  • Difficulty paying attention.

The person with delirium may also:

  • Appear agitated (or "revved up"), or the opposite: drowsier or quieter than usual.

  • Hallucinate or have delusions (false beliefs not in sync with the person's usual cultural beliefs).

It's common for the mental confusion to fluctuate throughout the day, with the delirious person sometimes seeming like his or her usual self and then, say an hour later, appearing much altered.

Delirium is usually a sign of a stress, such as an illness, affecting the body overall. Common serious causes include infections (such as urinary tract infections or pneumonia), abnormalities of blood chemistry (such as high levels of blood sugar or sodium), dehydration, or even excessive pain after surgery. Delirium can also be caused by or worsened by intoxication or by certain medications (such as antihistamines, which have side effects that influence brain chemistry).

Although younger people with healthy minds can develop delirium, elderly people and people with dementia are especially prone to becoming delirious when sick. A frail elder may also develop delirium when stressed by seemingly minor issues such as constipation, lack of sleep, or not having eyeglasses and hearing aids while in the hospital.

Research has shown that delirium is common in hospitalized patients; up to 50 percent of postsurgical patients may be affected. Unfortunately, delirium is often missed by hospital personnel.

Especially in a frail older person, delirium can be the only outward sign of a serious medical illness. For this reason, any new or suddenly worsened mental confusion needs to be promptly brought to the attention of a medical provider. Since a delirious person may not be able to answer questions properly, it's especially important for a caregiver to help describe the problem. Be sure the doctors realize that the mental confusion is new, or worse than usual.

Community Answers

Tootsie @ 60 answered...

Thank God, Caring.com warned me about delerium in my 83 year old mother and I was able to recognize it and understand what was happening. Every time she gets a UTI, she is like a time bomb about to go off. As soon as I suspect one, I get her to the doctor and amazingly they question my request for a urinalysis. Which comes back positive! But after a few days on antibiotics, she returns to her normal state of dementia - to our relief. No it isn't easy and it isn't always pretty, but knowing what is happening with her helps us cope.
When she admits that she cannot remember things, it helps when we sympathize with her and assure her it's O.K. that's why we are here - to help you remember. Unless she is experiencing delerium, it usually works! Thank you for making my life easier.

Paz2u answered...

It is destressing when Dr.'s say they can't listen to family they have to listen to the patient because she still is her own guardian. My mother has suffered from delirium that has been severe. You read how some get help and diagnosised early while others are out here fighing with Dr.'s who have no business being Dr.'s. This defination here is mild and very kind in its description to what we have experienced.

Paz2u answered...

This question would best be posed to one of the Dr.'s because I am not a Dr. but from what I have read on the subject it could be caused from the protein that forms plaque in the brain and does nerve damage thus causing seizures.

Jwc answered...

How timely this topic is. My mother was admitted to the hospital earlier this wk with what turned out to be bronchitis. On the phone with her this morning she seemed agitated and even a little delusional. It's impossible to reason with someone in this state and I was so taken aback because she's never been like this but she's had a bit of change lately. Two days after she moved into Assisted Living she fell, fractured her pelvis and was in rehab for 2 mos. After being discharged and only back in Assisted Living apt for 4 days, she wound up in the hospital with what's been diagnosed as bronchitis. I spoke to the nurse who confirmed her confusion this morning. I later spoke with my mother, never mentioned our earlier phone call and she's better. That was scary and sad at the same time, particularly when you just feel helpless.

Stu answered...

I have found it is very important to work with a doctor who specializes in geriatrics. Many symptoms in the elderly are very different. After 65, medicines react differently. Also a geriatrics doctor will assist with your loved one "making their own decisions" and dealing with delirium and confusion.

I find it frustrating with hospitalization and the changing of nurses and doctors on a daily basis. Many do not understand the elderly and will take your loved one off of all meds... and start over. Then you are dealing with withdrawl and confusion! It is important to use a patient advocate in that case. You should request one early on in the visit. Remember that is really not your Mom or Dad you are dealing with and "go with the flow" instead of reasoning or getting angry. This too will pass!

Jwc answered...

I agree, Stu, and my mom has a wonderful geriatrician. However, she does not have privileges at this particular hospital but was aware of what was going on. From my mom's recent hospital stays during the past 2 yrs, I certainly know how important it is for the patient to have an advocate for them, and there's no better person than me. I appreciate your comments.

Stu answered...

The fact that your loved one's primary geriatrician is not a doctor at the hospital is quite common. Then at the hospital the doctor's are part of a group and change daily. Even they don't agree with each other.

We had one doctor take Mom off of all her meds and tell me to take her back to the primary to put he back on after he discharged her. That meant withdrawl, unnecessry pain, and many more appointments. It is like I have no life outside of caring for Mom. That is when i found out about an advocate. Mom was delirious and we both had a meltdown before they would listen to me.

I also care for my mother's older brother and my husband has health issues. I often wonder what happens to elderly people who do not have an advocate. The medical profession makes it extra hard on the advocate and then stop and tell you to take care of yourself!!!! If it was not so sad, it would be funny! I am in a support group and go for counseling. I strongly recommend both to every caregiver.

A fellow caregiver answered...

for tootsie @ 60 It is not uncommon for elderly to get a UTI without feeling symptoms. My cousin works for the VA in spinal cord injury and with MS patients - another set of patients where symptoms are not felt. The VA did a study and determined that cranberry extract actually works as effectively as antibiotics. It is helpful to take a daily dose to eliminate the potential of future infections.

Caretakerdaughter answered...

I am so happy to see this article. A friend of mine is going through this stuff right now with her elderly mother. My 88yo mother has Alzheimer's and this is great info to have on hand and to keep fresh in my mind to help prevent it and to recognize it.

Maureen stachowicz answered...

My Mom, 88yo with mild alz. was hospitalized twice this month . First for UTI, then a week later with C Difficile as a result of the antibiotics. Because she can't tolerate so many drugs, I had to give her Compazine for nausea and vomiting regularly over a week to help keep the antibiotics down. 3 days after stopping the compazine, she began experiencing anxiety, restlessness and "tightness" in her legs and feet. She could not find a comfortable position and paced constantly until she couldn't pace any more. She would sleep a few hours then it began all over again. Her memory got worse. she couldn't concentrate on anything. (her baseline is she plays bridge and scrabble on her IPAD!!) Took her to ER where they ran tests to rule out UTI, disc problem, blood chemistries which were normal for her. They felt she'd become deconditioned as a result of the hospitalizations, which I agree with, but I still think she could have been withdrawing from the compazine as well. Then again all the illness could have aggravated her dementia. OR ALL of the ab.ove!!! She is now in short term rehab. (36 hours)No further agitation - looks better and is walking very well. She was supposed to move into Assisted Living from my home (where's she's been with me for 2 years) a few days after her first hospitalization. I think the stress of the change has played into this situation. She is agreeable to moving in to AL from rehab - probably within a week. They are all ready for her and a visiting nurse and a P.T. will probably check her a few times after that . This has been the most exhausting experience both physically and emotionally for both of us. Family is supportive, but nobody knows unless they live with this situation. Thanks for listening to this long story. It helps to write about it! (:-)

Lostmyway answered...

I'm 27, I have a moderate Opiate dependency, last few days I have experienced some very different mental problems from my usual ones, I have any number of diagnosed mental health issues depending on which Doctor I believe...

Now, this delirium seems very possible to what I've felt recently.

there's many symptoms, but by far the most distressing is abnormal paranoid-like thoughts that are so complex nobody understands what I'm trying to explain, they are usually negative thoughts about people I care about... Consiperices and such... its ruining every relationship I have left, which isn't many, its erratic by the minute, from fine to all out nonsense in seconds.... and most importantly, its new... Its not G.A.D, its not Agoraphobia, its not Psychosis (but like) its not my Depression, its something else, and something new, aside from that I fit every symptom above with frightening accuracy.

There's a lot of people talking about Delirium in older people, but I just want to know how it would effect a younger person, would the dementia like symptoms not be there? it seems the rest described above could really be what the problems is, also its connection to Opiates.

I can't cope with this, and I've coped with a lot before today, psychosis, agoraphobia, many, many things... but these irrational but fully formed thoughts about the people around me are too much at the moment.

I don't expect miracle answers from such vague information but any information on delirium in young people and its connection to Opiate based painkillers would help.


Ca-claire answered...

LostMyWay - I would make sure that you are seeing a Psychiatrist (MD), to make sure that you are on the proper meds, and working towards breaking the dependence on the opiates. Luckily, my primary MD recognized that my depression/anxiety/OCD needed to be managed by a specialist - as my history includes several drug failures. It's helpful also, that the Psychiatrist is also a Geriatric Psychiatrist, so he can help my Dad too.

It takes time to get things all balanced out and working well for each individual, so be patient, but get yourself thoroughly checked out since you feel this delirium is different from your other conditions.

Alzchild answered...

As my fathers POA I was unable to keep delirium at bay during his hospital stay. It was the first issue I discussed with staff upon his admittance and the first issue I addressed everyday. My 88 year old father had dementia, was admitted for a gall bladder infection and after laparscopic surgery, began to recover. But against my wishes the staff took him off all his normal meds and gave him large doses of the narcotic dilaudid. I requested an advocate, to meet with the dr's, to create a delirium plan...all to no avail. No one would listen to me. My dad slipped into delirium and never returned mentally or physically. He suffered a stroke 3 days later (staff didn't notice) and 2 days after that a heart attack. He left the hospital and died at hospice 2 days later. It is shocking how little medical personnel understand or recognize delirium. This is an important discussion everyone needs to have with medical staff for the elderly. Sadly my dad lost his life due to ignorance and indifference.

Vfelermorgan answered...

Very helpful. Thank you very much. Exactly what you have described happened to my mother.

Prana417 answered...

My father died just 18 months ago after 53 years of marriage and my mom has had to go through so much. My mom was diagnosed with dementia and depression. She was on Zoloft and Aricept for several months. She was happy and active again and stopped crying. Then she slowly started hearing voices. It got to be so much that she couldn't stop crying. We took her to the ER and they admitted her into the geriatric psych unit. She wanted to go home after two days. But they kept her a week and she got worse. She didn't fight the voices but listened to them and believed them. She would write down everything the voices said. She became paranoid and delusional. She's now on zyprexa and risperdal. The voices have decreased but she still has paranoia. She's now in short term skilled nursing facility while the meds get time to get in her system. So I wonder if taking her to the ER did more damage than good.

A fellow caregiver answered...

I am so thankful for a place to come for an understanding and answers for what I am experiencing with my mother. It's difficult and explainable. She's very much in denial that there is some wrong, but know one just rambles endlessly without making sense and jumping subject to subject without having something wrong with them. My mom will do this for hours and not stop and then become highly agitated and then starts to saying threatening things to me if I tell her she's acting out and there's something wrong and that she needs help. She will have the outburst and then act like nothing happened 10-15 minutes later and that I should be okay with her horrendous behavior with me and that there's something wrong with me. The reverse psychology isn't working. I don't know what else to do, but to keep my distance and mouth shut as to avoid the incidences. The verbal abuse is getting tiresome to me, but she thinks I am actually doing something to her. When all I have asked is for her to seek help. Either counseling or medication. She's very delusional about her behavior and when other people are around my mom pretends that everything is wonderful or she is blatantly insulting the entire time with negative comments and oversharing my personal business.

Daradar answered...

In response to those having difficulty getting a diagnoses or guardianship - we found out the hard way that for fear of lawsuits some physicians or their organizations will not diagnose the disorder(s) that make help (or harm) possible. My Dad's cancer doctor would use the word dementia in his paperwork upon my description of it, and with each visit incorporate little memory tests. While getting a physician's affidavit might be nearly impossible until the situation is horrible, it's nice to know there are those who will acknowledge, understand, and encourage. Mention the condition at every little appointment, keep up the conversation with every caregiver.