Delirium - Confused Thinking

General Information
Delirium is one of several causes of confusion. It is particularly common in elderly patients. Delirium causes consciousness to become clouded. Impaired awareness of the surrounding environment occurs. This may be as minor as simple misinterpretations and inattention or as severe as frank hallucinations. Patients often seem confused or disoriented as to time or place and may have visual or auditory hallucinations. Memory may be impaired. Sleep is often disturbed. Delirium develops quickly, typically within hours to days. Its severity usually fluctuates throughout the day. It is easy to be fooled into thinking that the delirium has subsided. Generally, there is an identifiable cause.

Commonly, delirium occurs as a reaction to infections, metabolic disorders, poor heart function, small strokes, temperature imbalance, drug reactions, and even urinary or fecal retention. Environmental changes as innocent as moving a patient to new and unfamiliar surroundings, such as a nursing home, can be the cause of delirium.

Careful examination by the patient’s physician is important to uncover health problems that may underlie the development of the delirium. Because delirium is associated with a wide variety of medications, it is important to make available to the physician a complete list of drugs, both prescription and nonprescription, that the patient is taking. Treatment of any underlying problem is the best way to reverse the delirious state. With proper management, the delirium usually clears in a few days, but, in a few cases, it may persist for several weeks before responding to treatment.

Important Points in Treatment
The treatment prescribed by the patient’s physician for underlying conditions is of first importance. Measures that focus mostly on the patient’s environment are equally important in speeding the clearing of the delirium and preventing its return. The patient will do best in a quiet setting, away from bustle and confusion, but not isolated or abandoned because isolation may worsen the delirium. Frequent attention by a relative or friend while the confusion is severe, and particularly at night, is helpful and reassuring. Visitors must be supportive and convey optimism.

Retaining or restoring familiar furnishings and memorabilia is particularly helpful if the patient is in new surroundings. Adequate lighting and the sensory stimulation provided by a television or radio are usually beneficial. Reorientation to time and date will speed recovery. Often radio or television news programs that reinforce the time and date are helpful.

If the patient is agitated, the physician may prescribe a mild sedative. The use of physical restraints often worsens the agitation. Restraints are best kept for moments of absolute necessity to protect the patient from self-injury.

Notify Our Office If ...

  • Abrupt changes in mental status occur.
There is any suspicion of infection or injury. Patients with impaired mentation are susceptible to infection and trauma without manifesting the usual or expected complaints.