Delirium

Justice Rahman, retired from the High Court, has a mind his former clerks still describe as a scalpel. Two days after his hip operation he stopped recognising his son. He pulled at his drip, insisted the nurses were thieves, was calm again by morning, then confused again by evening. The family thought it was the beginning of dementia. It was a urinary infection.

An illustration drawn from common experience. The people are invented; the pattern is not.

Understanding delirium

Delirium is a sudden change in attention and thinking, developing over hours or days and often fluctuating through the day. People may be agitated and restless, or quiet, drowsy and withdrawn, which is easier to miss. It is a sign that the body is under strain: infection, dehydration, surgery, pain, new medicines, alcohol withdrawal, or poor sleep in a noisy ward. Older people and those with dementia are most at risk.

Delirium is different from dementia. It comes on fast, and it often clears when the cause is treated.

Signs and symptoms of delirium

• Sudden confusion, or not recognising familiar people or places
• Attention that wanders, speech that does not make sense
• Agitation, fear or seeing things, or unusual sleepiness
• Symptoms that come and go, often worse at night

Treatment for delirium

Delirium needs urgent medical attention to find and treat the cause. Simple measures can prevent delirium in the first place. In a controlled study in the New England Journal of Medicine in 1999 of 852 patients aged 70 and over on a general medical service, a programme of non-drug measures, including orientation, sleep, glasses and hearing aids, hydration and early walking, reduced the number of patients who developed delirium (9.9% against 15.0%). Families matter here: a familiar voice and face are part of the treatment.

What getting better can look like

In Justice Rahman’s family, the first sign of recovery may be the morning he asks, a little embarrassed, why everyone looks so worried, then asks for his newspaper and his tea.

Common questions about delirium

What is the difference between delirium and dementia?

Delirium is a sudden change in attention and thinking that develops over hours or days and often comes and goes through the day. Dementia develops gradually over months or years. Delirium is a medical emergency, usually a sign that the body is under strain, and it often clears when the cause is found and treated.

Why do elderly people become confused after surgery or in hospital?

Sudden confusion in an older person in hospital is often delirium. Common causes include infection, dehydration, surgery, pain, new medicines, alcohol withdrawal and poor sleep on a noisy ward, and people with dementia are most at risk. It needs urgent attention from the treating doctor, and a familiar face and voice from the family help recovery.

When to see a psychiatrist

Sudden confusion in an older person is an emergency. Contact the treating doctor or go to hospital straight away.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• Inouye et al., New England Journal of Medicine, 1999