How families can help someone with delirium

Families often notice delirium before anyone else. What you tell the team can help them recognise it, and simple things at the bedside can make the person less frightened and confused.

You are the expert on their normal self

Staff meet your father for the first time when he is already ill, whereas you have known him for decades. Delirium is diagnosed by one change above all: the person is different from their normal self. Nobody can judge that better than you.

About 1 in 4 older people admitted to hospital have delirium at some point in their stay. And around 1 in 3 episodes start after admission, so someone who arrived clear-headed can become confused on day three or four. Hospitals should look for new changes at least daily, but delirium developing after admission is still often missed. A family member’s report remains important.

So say what you see, and be specific: when you last saw them well, and what is different now. Use the word delirium. Saying “He is nothing like his normal self. Could this be delirium?” is enough to start the right process. Worried families sometimes hold back for fear of being a nuisance, but this is information the team needs, and good staff know it. If the answer does not satisfy you, ask again, or ask someone more senior. If you feel the change is not being taken seriously, raising concerns with staff sets out what to say and how to escalate calmly.

And hold the quiet form in mind. Much delirium is hypoactive (the quiet form), in which the person becomes sleepy, flat and withdrawn rather than agitated. A patient dozing peacefully looks settled, and this is the kind of delirium most often missed. Unusual drowsiness is as much a warning sign as shouting or restlessness.

Tell the team what they cannot know

Once delirium is suspected, the team starts looking for causes, and much of what they need is in your head, not in the hospital notes. Useful things to tell them include:

• What the person is normally like: sharp, forgetful but managing at home, or already diagnosed with dementia.
• Medicines, including anything recently started or stopped, and how much alcohol they usually drink, including any recent reduction or stop.
• Hearing and sight. Do they use aids? Where are they?
• The days before admission: any new illness, poor eating or drinking, falls, disturbed nights.
• Previous episodes of delirium, for example after an operation. Having had it before makes it more likely again.
• Personality and preferences: the name they answer to, how they take their tea, what calms them, what upsets them.

That last item looks minor. It is not.

At the bedside

Start with your presence. A familiar face and voice can make someone with delirium feel safer. Sit quietly and, if they welcome touch, hold their hand. Say who you are.

Talk simply and gently, in short sentences, one idea at a time. Mention the day, the place and what happens next as part of natural conversation (“It’s Tuesday morning. You’re in the Western General. Lunch is coming soon.”), rather than testing them with questions.

If they say things that are not true, do not argue and do not play along. Respond to the feeling (“That sounds frightening. I’m here with you.”) and steer the conversation somewhere safe. The belief feels completely real from the inside, and arguing rarely works.

After that comes the kit: glasses on and clean, hearing aids in and working (with spare batteries in the drawer), dentures in, and a clock or calendar where they can see it. Bring a few things from home, such as photographs, their own blanket, or the crossword page. Familiar music, played quietly, helps some people. Keep daytime visits lively and the evening calm.

Drinks, meals and moving

Dehydration and missed meals both cause delirium and slow recovery from it. A person with delirium may forget to drink, get distracted mid-meal, or no longer notice thirst at all.

First ask staff what foods, drink textures and amounts are safe, including whether there is a swallowing plan or a fluid restriction. Do not give food or drink if the person is too drowsy to swallow safely. Follow the care plan. If staff say it is safe, offer small amounts often; little and often usually works better than a full glass presented twice a day. Offer favourite drinks and use the person’s own mug if appropriate. Some foods count towards fluid, but check what is allowed. Tell staff if you notice a dry mouth, dark urine or increasing drowsiness.

Moving matters as well. Lying in bed drains strength within days, and getting up again, even briefly, is part of the treatment of delirium. Ask the team what is safe, then encourage it: sitting in the chair for meals, standing with help, a short walk along the corridor.

When you cannot be there

No one can hold a bedside vigil all day, and no one should try. Share the visiting around the family if you can, because short, regular visits are worth more than one exhausted marathon.

And what you tell staff keeps working after you leave. Anne’s briefing about the garden and the milk was doing its job at two in the morning, while she was asleep. Phone the ward when you cannot come, ask for the nurse looking after your relative, and ask them to phone you if anything changes overnight.

Afterwards

Most delirium improves over days, though some episodes last weeks or months, and recovery of thinking often lags behind recovery of the body. The bedside habits still apply at home: regular drinks and meals, glasses and hearing aids on, a steady routine, daylight during the day and quiet at night. Follow any discharge advice about swallowing, food texture, fluid limits, mobility aids and supervision. After delirium: what to expect covers this period properly.

Looking after yourself

This is tiring, and often upsetting, and it can go on for weeks. You will be more use to your relative if you are not running on empty. Eat, sleep, and take your turns away from the ward without guilt. Share the caring around the family, and accept help when it is offered.

You count as a carer, whether or not you would use that word about yourself, and there is practical help for carers. In the UK, Carers UK (0808 808 7777) advises on benefits, breaks and your rights at work. You can ask your local council for a carer’s assessment, a review of the support you need. Age UK (0800 678 1602) can help with care and money worries in older age. Outside the UK, ask local health or social-care services about equivalent support for carers. If your own mood, sleep or anxiety is suffering, tell your own doctor; that matters too.

Printable guides for the ward