Delirium is common in the last days of life. It is also common in people who are seriously ill and then recover completely. On its own, it does not show which is happening.
Delirium affects up to half of people in their last days of life. When someone is dying, several of the things that disturb the brain are often present at once: organ failure, dehydration, infection, strong painkillers, exhaustion. Confusion, restlessness and hallucinations at this stage are expected, and they can be eased.
Delirium is also one of the commonest complications of serious illness in older people, and most of those people are not dying. It happens after a broken hip, a chest infection or an operation, in people who then go home a few weeks later.
How to tell the difference
You cannot tell from the delirium alone. What matters is the illness behind it, and how the person has been overall. Can the illness be treated, and is it responding to treatment? Has the person been going downhill for months, or were they well a fortnight ago? Are they still eating and drinking? And over the course of several days, are things getting better or worse? The team looking after them can answer these questions.
Ask directly
Doctors usually give a clear answer to a clear question. You could say: “Is this confusion something you expect to improve, or is it part of him becoming more unwell overall?”
If you want to know whether the person is thought to be dying, ask that plainly. It is a reasonable question to ask.
Comfort still helps
Someone with delirium who seems distant, agitated or frightened is still there, and comfort still helps. A familiar voice, a hand to hold, ordinary talk about ordinary things. These help during recovery, and they help at the end.
When to get help
New confusion that has come on over hours or days needs medical advice the same day. Phone the GP practice, or 111 when it is closed. Phone 999 if the person cannot be woken, has collapsed, or has new weakness or new trouble speaking. When you speak to someone, say what has changed. Then ask: could it be delirium?