What to expect after delirium

The infection has been treated, the drip is down, and the ward is talking about discharge. Yet your mother is still not quite herself. Recovery from delirium is usually slower than families expect.

Recovery is gradual, and uneven

Most delirium improves over days once the causes are treated. But the mind’s recovery often lags behind the body’s. A person can be walking and eating well while their concentration, memory and confidence are still catching up. Progress is also uneven: a good day, then a flat one, then two better ones. Judge it across weeks, not days.

Some episodes last longer. Delirium can persist for weeks, sometimes months, especially in people with dementia or after a severe illness, and it can carry on after every trigger has been found and treated.

What helps at home

The same things that treat delirium in hospital help recovery at home:

• Regular drinks and meals, little and often if appetite is poor
• Glasses and hearing aids on, clean and working
• A steady routine, with daylight and activity in the day and quiet at night
• Getting up and moving every day, building up gradually
• Familiar faces, and one conversation at a time rather than a noisy room
• A calendar and clock in view

Follow any discharge advice about swallowing, food texture, fluid limits, mobility aids and supervision. Do not give food or drink if the person is too drowsy to swallow safely.

Sleep often takes weeks to settle. Short naps are fine; long daytime sleeps that push the night out of shape are worth gently discouraging.

When delirium persists

If confusion or drowsiness is continuing for weeks, ask for a review rather than accepting it as the new normal. Two questions are worth putting to their doctor or the hospital team:

• Has anyone looked again for causes? Infections can return, constipation and dehydration creep back, and medicines that worsen confusion sometimes stay on the list longer than they should.
• Is this being called dementia? A new diagnosis of dementia should not normally be made while a person is still delirious, because thinking cannot be fairly judged during delirium. Major decisions, such as whether someone can manage at home, should not rest on how the person is in the depths of an episode.

Persistent delirium is hard for everyone. It does still improve in many people, slowly, and the practical care above keeps helping throughout.

Will they get fully back to normal?

Many people return fully to their old selves. Some do not; memory and concentration can remain below what they were before the illness, particularly in older people, after long or severe episodes, and in those with dementia. Doctors cannot predict this well for any one person, and we would be wary of anyone who claims otherwise. Time, rehabilitation, good sleep, food and drink all help.

If memory or thinking has not returned to normal after some weeks, ask their doctor for a review. That review can check for anything still driving the problem and, where needed, arrange a proper assessment later, once the delirium has fully settled.

Memories of the episode

Some people remember nothing. Many remember fragments, and some remember a great deal, vividly; the hallucinations and fears can return later as intrusive memories, particularly after intensive care.

Talking helps. Fill in the gaps gently, explain what was real and what was the illness, and let them tell you what they experienced, more than once if they need to. Explaining that it was delirium, a recognised medical condition with a name, helps people make sense of frightening memories. If distressing memories, nightmares or anxiety keep returning, raise this with their doctor; there is help for this.

Watching for it coming back

One episode of delirium makes another more likely. Know the early signs and act quickly if they appear: new confusion, unusual sleepiness, sudden suspicion, or a night turned upside down. New sudden confusion needs medical assessment now; follow the routes on Get help now. Knowing the signs may help you spot another episode sooner.