Delirium: When Confusion Becomes a Medical Emergency
Delirium: When Confusion Becomes a Medical Emergency
Everyone forgets where they put their keys or if they closed the garage door. But when does forgetfulness and confusion signal something more serious?
A fast and unexpected change in thinking can be a sign of delirium. This medical condition develops over hours or days and should be treated as an emergency—especially in older adults.
Why Delirium Matters
Delirium may sound like stereotypical behavior in older adults, but it’s not something to ignore.
“Confusion or a little bit of slipped memory is common in a lot of adults, but it’s not normal,” says Natalie Sanders, DO, a geriatrician at University of Utah Health.
Preventing delirium is critical to prevent serious health outcomes, including:
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Higher risk of death
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Longer hospital stays
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Increased complications such as falls
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Loss of independence or function
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Higher chance of hospital readmission
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Greater risk of developing dementia
After experiencing delirium, some patients are not able to return to their baseline abilities and may need more care from family members or in a nursing facility.
How to Spot Delirium in a Loved One
Hospital teams are skilled at treating medical needs, but noticing subtle changes in a patient’s thinking can be difficult. How a patient normally behaves—whether outgoing, quiet, or sharp—isn’t always clear to the care team.
“It is so important for family to be involved in the patient’s care and be able to tell the care team what their baseline is,” says Alisyn May, PharmD, a clinical pharmacist at the University of Utah College of Pharmacy. “If you see a change, bring it up. You know your loved one best.”
Signs of delirium include:
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Sudden or fluctuating confusion: While sudden confusion is common, so is a fluctuation of confusion—feeling confused at one moment and then fine another.
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Trouble paying attention: They may be easily distracted or struggle to follow a conversation.
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Disorganized thinking: This may look like rambling speech, odd conversations, hallucinations, or delusions.
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Changes in activity: Delirium can show up as increased agitation and restlessness (hyperactive) or as quiet, slowed, or withdrawn behavior (hypoactive).
Delirium is a common reason families bring an older adult to the hospital. Up to 25% of patients over age 65 arrive already experiencing delirium. During a hospital stay, the risk increases—up to 56% of older adults may develop delirium after they’re admitted.
While there’s no approved medical treatment for delirium itself, prevention is highly affective.
How to Prevent Delirium
The goal of prevention is to keep a person as close to their normal baseline as possible. These steps can help both in the hospital and at home:
- Ensure proper eyeglasses and hearing devices are worn correctly and used consistently.
- Remind them of the day, time, place, weather, etc.
- Support healthy sleep and minimize daytime napping.
- Encourage physical activity.
- Make sure they eat regularly and stay hydrated.
- Avoid high-risk medications.
Certain medications can increase the risk of delirium, such as over-the-counter sleep aids containing diphenhydramine (Benadryl, Tylenol PM).
“Make sure that patients are always talking to their pharmacists or providers, asking if the medication is OK,” Hansen says.
How to Get Help
Awareness and prevention of delirium will make a significant impact on your loved one’s continuing health. Simple tasks like remembering to put on eyeglasses before getting out of bed or going for a brief walk can make significant impact.
However, if you notice concerning symptoms, seek medical care right away.
The Hospital Elder Life Program (HELP) at University of Utah Health works to prevent delirium and functional decline in adults 65 and older during a hospital stay. This evidence-based program lowers the risk of delirium and supports better outcomes for older patients. U of U Health is an Age Friendly Health System—an approach that ensures care for older adults that ensures health care is safe, personalized, and aligned with each person’s goals and needs.
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