Caring for a Person with Delirium

Delirium is very common in people with advanced illness. With delirium, people have times when they are suddenly confused and unaware of what is going on around them. They may become agitated and restless or withdrawn. Delirium can be very upsetting for family members to watch. If your loved one develops signs of delirium, let his or her healthcare provider know right away. In some cases, the cause of the delirium can be treated. In others, steps can be taken to help manage delirium and ensure your loved one’s safety and comfort.

Man observing his loved one suffering from delirium.

What are common causes of delirium?

Delirium often has multiple causes. These can include:

  • Infections

  • Medicines

  • Serious or terminal illness

  • Hospitalization

  • Changes in environment

  • Drug and alcohol abuse

  • Electrolyte imbalance

  • Pain

  • Other problems, like anemia or nutrition deficiency

What are the types and symptoms of delirium?

There are 2 main types of delirium: hypoactive and hyperactive. People can have 1 or both types:

  • Hypoactive. In a hypoactive state, people are sleepy and withdrawn. They may show little interest in their surroundings.

  • Hyperactive. In a hyperactive state, people are excitable and agitated. They may become violent. And they may believe in or see things that aren’t there.

Most people with delirium will also have the following symptoms:

  • Changes in sleep patterns

  • Confusion about time and place (disorientation)

  • Wandering attention

  • Disorganized thinking

  • Problems with memory and speech

  • Changes in mood or personality

  • Hallucinations

How is delirium treated?

Your loved one’s healthcare provider and healthcare team will try to identify the cause of the delirium and treat it, if possible. Sometimes, the cause cannot be found. Or treatment may be available, but it may be too much of a burden at this point in their illness. In such cases, the main goal of treatment is to manage the delirium and keep your loved one safe and comfortable. You may be told to do the following:

  • Provide safe and familiar surroundings. Keep your loved one’s room clean and well-lit. Have familiar objects nearby, like a favorite blanket and family photos. Add a clock next to the bed and a calendar on the wall to help your loved one keep track of time.

  • Limit contact with strangers. Try to make sure that your loved one receives care from the same healthcare providers or caregivers. Keep visitors restricted to family members or close friends to reduce confusion.

  • Maintain a regular day and night schedule. During the day, open blinds and windows or keep the lights on to encourage your loved one to stay awake and alert. During the night, dim the lights and keep noise levels low to encourage sleep.

  • Expect sudden changes in behavior. There may be times when your loved one is normal and alert. But other times he or she is not fully present. Your loved one may forget who you are. He or she may also imagine things or speak to people who aren’t there. Try to stay calm during these episodes. It may help to provide a gentle touch or reassuring words. Or you may choose not to speak and simply listen.

  • Use positive language. Try not to raise your voice or argue with your loved one. Keep conversations simple. If your loved one is confused, state simply and calmly where he or she is and what is going on.

  • Minimize the use of restraints and encourage movement as soon as possible. These can make a person more anxious, afraid, or angry and increase confusion. If needed, arrange for a 24-hour caregiver or nurse, so your loved one is never left alone. Or take turns sitting next to the person’s bedside with other family members and friends.

  • Alert the healthcare provider if your loved one’s delirium worsens. If needed, medicine can be prescribed to help your loved one sleep or stay calm.

Treatment of delirium as death nears

Treatment of delirium may change when your loved one is near death. The healthcare provider and healthcare team can help prepare you for what to expect in the last days of life. If delirium is severe, ask the healthcare provider about choices for keeping your loved one comfortable. Don’t be afraid to ask questions or seek help at this time. If more support is needed, other healthcare team members, like a social worker or spiritual advisor, can help.

Helpful tips for preventing delirium

Tips to help prevent delirium include:

  • Use visual and hearing aids as needed

  • Manage pain

  • Keep watch for the use of certain medicines or avoid them altogether. Certain medicines can trigger delirium.

  • Prevent medical complications or treat them if they happen. Some medical conditions are known to cause or worsen delirium.

Delirium and the caregiver

Caregivers of people with delirium play an important role that has 3 parts:

  • They try to prevent delirium and spot it if it happens.

  • They act as advocates for their loved ones.

  • They help to keep watch for symptoms.

But caring for people with delirium can take its toll on caregivers. They need support to cope with the stress and emotions of providing such care. If you are a caregiver to a person with delirium, you may find a support group or educational materials helpful during this stressful and emotional time.