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Questions families ask about delirium
Short answers to common questions about delirium, with links to the relevant page or section.
If the confusion is new and has come on over hours or days, do not read first. Get medical help now.
At the start
What should I do if someone suddenly becomes confused?
Delirium (acute confusion) is a medical emergency. Outside a care setting, call local emergency services now. In a hospital, care home or nursing home, tell staff immediately.
What is delirium?
Delirium is sudden confusion caused by physical illness, injury or medicines. It is common, it is serious, and it often gets better once the cause is found and treated.
Is delirium the same as dementia?
No. Delirium comes on over hours or days and often gets better. Dementia develops over months and years and is long-lasting.
Can a urinary tract infection (UTI) cause confusion?
Yes, a urine infection can cause delirium in an older person. But it is often blamed when it is not the cause, and stopping there can mean the real cause is missed.
Does a positive urine test explain the confusion?
A positive result alone does not establish the cause.
Why is my mother confused after surgery?
Confusion in the first days after an operation is usually delirium. It is common, and it often improves as the person recovers from the surgery.
While it lasts
What is the treatment for delirium?
There is no tablet that cures delirium. Treatment means finding and treating the causes, and supporting the person until the brain recovers.
Why are they still confused after antibiotics for a UTI?
Delirium can persist. Ask about the causes, progress and review plan.
How long does delirium last?
Delirium can last days, weeks or months. Continuing confusion needs a care and review plan.
Can delirium make someone very sleepy or withdrawn?
This may be hypoactive delirium. A new change needs urgent assessment.
Why is delirium worse in the evening or at night?
Delirium is usually worse in the late afternoon, evening and night. A clear morning does not mean it has gone.
Can delirium cause hallucinations or frightening beliefs?
Seeing things that are not there is common in delirium. To the person, what they see feels completely real.
How can I help someone who has delirium?
A familiar face and a calm voice are treatment, not just company. Bring what helps the person make sense of the world, help them eat and drink, and tell the staff what normal looks like for them.
What if they refuse food, drink or medicines?
Involve the care team and ask for a safe plan.
Can someone die from delirium?
Yes. Delirium can contribute to death, and it often occurs in people who are seriously ill. Many people recover. Read about the risks and what to ask the team.
Is delirium a sign that someone is dying?
Sometimes. Delirium is common near the end of life and also occurs in people who recover. The team needs to assess the person’s whole condition.
Afterwards
Can someone leave hospital while still confused?
Ask what support and review will be arranged.
Will she get back to normal after delirium?
Many people do get back to their usual selves, though it often takes longer than families expect. Some are left with lasting changes.
Will they remember any of this?
It varies. Some people remember nothing about an episode of delirium. Others remember fragments, or remember frightening scenes very clearly.
Does delirium lead to dementia?
Having had delirium raises the risk of being diagnosed with dementia later. Most people who have delirium do not go on to develop dementia soon afterwards.
Did we cause this? Should we have spotted it sooner?
No. Delirium is caused by physical illness, injury, surgery or medicines. Delirium can be difficult to recognise. Families should not blame themselves for not knowing what it was.
Did delirium cause my relative’s death?
Delirium may have contributed. Understanding what happened means looking at the whole illness. You can ask the treating team for an explanation.
More questions families ask
These answers are general information. Ask the clinical team to explain what applies to this person.
What tests might the team do?
The team will ask what changed and when, examine the person, review medicines and look for physical causes. In hospital or long-term care, staff may use the 4AT (or a local alternative) when signs suggest delirium. In intensive care or immediately after an operation, a different assessment may be used. Further blood, urine or other tests depend on the findings and the setting.
What if the person refuses help?
A diagnosis of delirium does not, by itself, decide whether a person can make a particular decision. Capacity is assessed for a particular decision at a particular time, and legal processes vary by country. Ask staff to explain the decision simply, support the person to decide and assess capacity where relevant. If urgent assessment is refused or safety is at risk, tell the clinician or emergency service.
Why might staff ask someone to stay with them?
One-to-one observation may be used when staff are concerned about immediate safety, distress or wandering. It is not itself a diagnosis of delirium. Ask what risk staff are responding to, what support is planned and when the plan will be reviewed.
Can an operation be planned to reduce delirium risk?
Ask the team how they will support orientation, hearing and vision, fluids and food, movement, pain relief, sleep and medicines. NICE recommends a tailored set of measures for people at risk. Tell staff what is usual for the person and what helps them feel safe.
What should I ask if staff say it is dementia?
Ask what has changed from the person’s usual self, when it began and whether delirium has been assessed. If it is difficult to distinguish delirium from dementia, NICE recommends managing delirium first.
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