Delirium (acute confusion): get medical help now

This page is general information, not advice about your particular relative. Only the clinicians who can examine them can give that. If in doubt, get them seen.

A sudden change in someone’s thinking, memory or alertness, arriving over hours or days, needs a doctor or nurse to check the person now. Do not wait to see if it settles.

What you might be seeing

Delirium is a sudden change in a person’s mental functioning with a physical cause behind it: an infection, a new medicine, dehydration, pain, surgery, or several of these at once. The common signs are:

• Being disorientated about time and place, or clearly more confused than normal
• Drowsiness, where the person is much sleepier than usual, drifts off mid-sentence, or responds much less than usual. If they are hard to wake or barely responding, call local emergency services immediately.
• Restlessness or agitation, sometimes with fear or anger
• New suspicion of family, carers or staff, without any clear reason for it
• Seeing or hearing things that are not there
• Awake at night and asleep by day, with much of the night spent awake and much of the day asleep

The symptoms may come and go over the day, and evenings and nights are often worse, so the person can still have delirium even if they have a clear conversation in the afternoon.

And watch for the quiet form. A person lying still and dozing can look peaceful, yet this sleepy, withdrawn form is very common, and staff miss it more often than any other kind.

Is this delirium or dementia?

Ask one question: is this person different from their normal self, and did the change arrive within hours or days? Dementia usually develops over months or years. Delirium starts over hours or days.

You do not need to be certain, and nobody expects you to make a diagnosis. A clear description of a real change is enough to set things moving. More on telling the two apart.

What to do, by where the person is

The person may not recognise the change or may refuse help. Delirium does not automatically mean that they lack capacity. Keep explanations calm and simple. If urgent assessment is refused or safety is at risk, tell the clinician or emergency service. Capacity should be assessed for the particular decision at that time, under the law where you live.

If you raise the change and staff do not act on it, ask again. Raising concerns with staff gives you words to use, phrases for when it is put down to age or dementia, and how to ask a more senior member of staff for help.

If you are not sure whether it is an emergency and the person is getting worse, treat it as one and call local emergency services immediately.

Have this ready

Whoever you speak to, a short clear account helps them act. These points cover most of it:

• What the person was like a week ago, in a sentence or two
• What changed, and when it started
• Their medicines, including anything started or stopped in the past couple of weeks, and how much alcohol they usually drink, including whether they have recently reduced or stopped drinking
• Any illness in the past few days: fever, cough, pain, a fall, constipation, poor drinking
• Whether anything like this has happened before
• Your phone number, if you are not staying with them

If you can, take the medicine boxes with you, or photograph them, and bring glasses and hearing aids too. A person who can see and hear properly is much easier to assess, and often less frightened.

Words to use

Use plain English and the word delirium. Staff may find another explanation, but the sudden change still needs to be checked.

More questions

Why is she worse in the evening?
Can a urinary tract infection (UTI) cause confusion?
All questions families ask