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If you are worried about delirium, get medical help now
- New sudden confusion needs medical assessment now. Contact the urgent or emergency medical service where the person is. In England, call 999 or go to A&E. In Scotland, contact the GP urgently if open; otherwise phone NHS 24 on 111. Outside the UK, follow local health-service guidance.
- Call the local emergency number immediately (999 in the UK) if the person is hard to wake, barely responding, struggling to breathe, showing signs of a stroke, having a seizure, has had a head injury, or is deteriorating rapidly.
- Tell whoever you reach what the person was like a week ago, and what has changed.
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 medical assessment 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 muddled 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 the local emergency number immediately (999 in the UK).
- 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
- Sleep turned upside down, with much of the night spent awake and much of the day asleep
The symptoms come and go over the day, and evenings and nights are often worse, so an hour of clear conversation in the afternoon does not rule delirium out.
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 A person lying still and dozing can look peaceful, yet this sleepy, withdrawn form is very common, and staff miss it more often than any other kind.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 develops over months and years. Delirium arrives in a weekend.
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
At home
Get medical help now. Contact the urgent or emergency medical service where the person is. In England, call 999 or go to A&E. In Scotland, contact the GP urgently if open; otherwise phone NHS 24 on 111. Outside the UK, follow local health-service guidance.
Describe the change and say the word delirium. Do not wait a day or two to see whether it settles.
In hospital
Tell the nurse looking after the person immediately. Describe the change from normal, with times, and ask directly for a delirium assessment.
If the person is hard to wake, barely responding or deteriorating rapidly, use the call bell and ask for an emergency clinical review now. If there is no prompt response, ask for the nurse in charge.
In a care home
Tell the senior carer or nurse on duty immediately what has changed and when it started, and ask them to arrange medical assessment now.
Ask them to put the word delirium in the notes. If the person is hard to wake, barely responding or deteriorating rapidly, call the local emergency number immediately (999 in the UK).
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 it is waved away, do not leave it there. Raising concerns with staff gives you words to use, phrases for when it is put down to age or dementia, and a calm way to escalate if you are not being heard.
- cannot be woken, or barely responds when you speak to them or touch them
- is struggling to breathe
- shows signs of a stroke, such as a drooping face, weakness in one arm, or lost or slurred speech
- has hit their head in a fall, particularly if they take blood-thinning medication
- has a seizure (a fit)
- is becoming more unwell in front of you, over minutes or hours rather than days
If you are not sure whether it is an emergency and the person is getting worse, treat it as one and call the local emergency number immediately (999 in the UK).
New sudden confusion, unusual drowsiness or a clear worsening from the person’s usual mental state needs medical assessment now. Contact the urgent or emergency medical service where the person is and follow local health-service guidance. For the emergency signs above, call the local emergency number immediately. If you are unsure which service to use, or cannot obtain prompt assessment, use the emergency number. Do not wait to see whether it settles, and do not let the person drive themselves.
If there is an agreed palliative-care plan: contact the person’s palliative-care, hospice or primary-care team urgently and follow that plan. In the UK, this may be the GP team. Priorities and treatments may differ at the end of life.
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 any recent reduction or stop
- 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.
Delirium action guide (PDF)
This page as a printable one-page guide, with the checklist.
Download the Delirium action guide (PDF)Words to use
“My mother is 84 and lives alone. She is normally independent, with a good memory. Since yesterday she has been muddled and very sleepy, and she is not herself at all. I think this could be delirium. She needs urgent medical assessment.”
“He is much more confused than he was before the operation. This is a sudden change from his normal. Could you assess him for delirium, please?”
Use plain English and the word delirium. Staff may find another explanation, but the sudden change still needs to be checked.