Delirium is a frequently encountered form of confusion that is very frightening to family and friends as well as to the delirious person. Delirium presents as a sudden and often severe confusion as a result of severe medical illness, medication, surgery, hospitalization, or drug or alcohol abuse. Delirium occurs in 10-20% of hospitalized adults, 30-40% of hospitalized elderly, and up to 80% of those in ICU. Delirium is especially prevalent in persons who are demented.

Delirium and dementia are often confused. However, the differences are important to know. Dementia is an irreversible deterioration of mental skills and may be sudden in onset such as with stroke, head injury, or brain tumors. Dementia is more often a slow progressive decline over the course of months to years such as with Alzheimer’s disease. Delirium is sudden and reversible but may last for a few hours or as long as several weeks or months.

A major risk factor for developing a delirium is being demented. The dementia may be mild and/or undetected, which adds to the surprise when a delirium develops. Those who are demented need to be monitored more carefully for risk factors for delirium especially as they age. Potential triggers for delirium are visual or hearing impairment, poor nutrition, dehydration, terminal illness, multiple medical problems, medications, multiple medications, surgery, sudden severe illness, infection (especially watch for urinary tract infections in elderly and demented), hospitalization, being moved to a new living arrangement, being placed in an intensive care unit, and alcohol or medication withdrawal.

Medical treatment for delirium includes managing the underlying causes such as stopping suspect medication or treating an infection. It is helpful to make sure that fluids and nutrition are provided. Hospitals or moving to a new living arrangement can often trigger a delirium. Avoid or minimize room changes and use of restraints. Minimize use of psychotropic medications and discontinue as soon as the underlying condition improves. Provide adequate light and opportunities for natural light. If possible, keep the delirious person in a familiar environment with familiar caregivers. If they must be hospitalized, have them returned to their home environment as soon as possible.

When interacting with someone with a delirium be calm and reassuring. It is critical to approach the confused person from where they can see you coming, identify yourself, and address them by name. Avoid confrontation and arguments. Be reassuring and don’t deny their reality. Don’t try to use logic or long explanation, as the person is confused and will not understand. Keep noise and distraction to a minimum. Provide orientation such as referring to a clock or calendar often if needed.

If you are a partner or caregiver for a delirious person, the good news is that the delirium clears with time after the cause has been resolved. It is often helpful to get support for yourself during this traumatic time.