Yes. Delirium can contribute to someone’s death. It can lead to serious complications and make recovery from illness more difficult.
Delirium can affect eating, drinking, swallowing and movement as well as thinking. A person may become too drowsy or confused to eat and drink enough. Food, drink or saliva may go into the lungs and cause a chest infection. They may fall or spend long periods unable to get out of bed. Some of these complications can be life-threatening.
People with delirium are also often seriously ill already, or have health problems that make recovery harder. The illness that brought on the delirium, such as a severe infection, may itself be life-threatening. Often several problems contribute to a person’s death, and it is difficult to separate their effects.
Many people recover from delirium. For someone who is ill now, the team needs to assess the causes, the person’s health before this illness, and how they are responding to treatment.
You can ask directly: “Could they die from this illness? What are you most worried about, and what is being done to help?”
How big is the risk?
The risk varies a great deal. It depends on the illness causing delirium, how unwell the person is, their usual health, and any complications. Their progress over the next hours and days also helps the team judge what is likely to happen.
Research shows that people with delirium have a higher risk of dying than people without it. This increased risk is seen during the illness and can continue afterwards. Some of the difference reflects the serious illness and health problems that make delirium more likely. Delirium can also add to the problems a person is facing.
Figures from research describe groups of people. They do not give a reliable prediction for your relative.
Ask the team: “How serious is this for them? Are they improving? Is there a risk they might die, and how certain are you about what to expect?” You can ask for another conversation as their condition changes.
What one study found
One US study looked at 967 emergency department visits by people aged 75 or over. Within 30 days, about 17 in 100 of those with delirium had died, compared with about 4 in 100 of those without delirium. About 83 in 100 and 96 in 100, respectively, were alive at 30 days.
These figures show why delirium needs serious attention. They describe one group of older people selected for assessment in one hospital. They do not show how many deaths were caused by delirium, or what will happen to your relative. Being alive at 30 days also does not mean someone has fully recovered.
What should the team be doing?
The team should look for and treat the causes of delirium, check for complications, and review the person’s progress. There may be several causes, and a new problem can develop while another is improving.
Care includes helping the person get enough food and fluid, checking swallowing when needed, helping them move safely, relieving pain, and protecting their skin. Medicines should be reviewed, including any that may worsen confusion or make the person too drowsy.
Tell staff about changes you notice: eating or drinking much less, coughing when swallowing, becoming harder to wake, new breathlessness, or suddenly being less able to move. Ask what the plan is for each problem.
Follow the team’s advice about food, drinks and swallowing. If the person is too drowsy to swallow safely, do not give food or drink by mouth; get help from staff urgently. At home, someone who is hard to wake needs emergency medical help.
Families can provide useful information and familiar support. Responsibility for assessment, treatment and safe care remains with the clinical team.
Keeping the person comfortable
There are often causes or symptoms the team can treat. Pain, constipation, a full bladder or problems with medicines may add to delirium. Treating these can improve comfort and sometimes reduce the confusion.
When the person is in the last days of life, their illness may mean that the delirium will not clear. Care then focuses on comfort and relief of distress. The team should explain which treatments are likely to help, taking account of the person’s wishes and the burden of tests or treatment.
A familiar voice, a calm room or gentle contact may help. Watch how the person responds. Some people welcome conversation or touch; others need less stimulation. You do not have to keep talking or stay at the bedside all the time.
If the person seems frightened, restless or uncomfortable, tell the team. Medicines may be needed for severe distress. Ask what the medicine is intended to do and how its effects will be reviewed.
You can say: “They seem distressed. What do you think is causing it, and what more can be done to help?”
More: Is delirium a sign that someone is dying? and Did delirium cause my relative’s death?
When to get help
If the confusion is new, seek medical help now. In hospital or a care home, tell staff immediately. At home, phone local emergency services. If the person has an agreed plan for care at the end of life, follow that plan and contact the named care team urgently.