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Raising concerns with staff

Page last reviewed: July 2026

If you think a relative has delirium and staff have not noticed it, say so. Delirium is often missed. You may be the only person on the ward who knows how your relative normally thinks and behaves, and that information can help staff recognise it.

This page is about how to speak up, not about making a complaint. It is general information, not advice about your particular relative. Only the clinicians who can examine them can give that.

Why delirium detection often relies on families

Delirium is often missed. In many hospitals only a fifth to a third of cases are picked up. Staff may notice that someone is confused, write “acute confusion” in the medical record, and even find and treat a cause, yet never say the word delirium, to each other or to you. So families watch the delirium happen, the person becoming sleepy, frightened, agitated or confused, and never hear it named.

You also hold useful information that may not be clear from a chart: what this person’s normal thinking looks like. The ward staff met your mother on Tuesday. You have known her for decades. A doctor can’t tell from a single visit whether this is how she always is. You can, at a glance. That knowledge only helps her if you say it out loud.

What makes staff act

A busy nurse or doctor is most likely to stop and take notice when a concern is short and specific. Three things help, in this order:

Describe the change from normal, with times and examples. These are more useful than adjectives. “She is not herself” is a fair start; “On Sunday she was doing the crossword, and today she can’t follow a sentence” is evidence.
Use the word delirium. Using the medical term tells staff what you want them to check in a way that “confused” does not. You do not need any other medical language.
Ask a question that needs an answer. “Could a doctor assess him for delirium now?” is much harder to leave hanging than a general worry, and it tells staff exactly what you are asking for.

Put together, it can be as plain as this:

Describing the change to staff

“Dad is not himself. Yesterday he was chatting and joking; today he keeps asking where he is, and he is too drowsy to finish a meal. This came on quickly. I think it could be delirium. Could a doctor assess him now?”

Hospitals use bedside assessments for delirium, such as the 4AT. Different hospitals use different tools. If nothing seems to be happening, you can ask: “Could someone do a delirium test? What tool do you use here?”

Keep a short note. Write down what you see, with dates and times, in a notebook or your phone. “Tuesday 6pm, thought I was her sister. Wednesday morning, fine. Wednesday 9pm, trying to pack.” Delirium comes and goes, and your notes may be the only record of the pattern.

What if you think delirium is being missed?

Sometimes a sudden change is explained as “old age” or “the dementia”. Neither explains a change over hours or days. Dementia changes a person over months or years, and age on its own does not make anyone suddenly confused. Delirium also often occurs on top of dementia, which is when it is easiest to miss. Keep returning to how quickly the change happened:

If you hear “it is the dementia”

“I know she has dementia, but this is not her dementia. Her dementia changes slowly, over months. This happened between Tuesday and Thursday, and she is seeing cats in the room, which she has never done. Could this be delirium on top of the dementia?”

If you hear “it is BPSD”

“I understand that these symptoms can occur in dementia. But this is a sudden change from how she normally is. What has been checked?”

If you hear “it is just old age”

“Being 88 does not explain becoming this confused in two days. Last week he was doing his own shopping. Something new is going on, and I would like him assessed for delirium.”

Words for common situations

These are the concerns families raise most often, each with words you can use or adapt. Say them in your own way. You do not need a particular phrase to raise a concern.

They are unusually sleepy, hard to wake or barely responding

The quiet form of delirium is common, and a person may become drowsy, flat and withdrawn. It is particularly easy to miss because a sleepy patient causes no trouble on a busy ward. Being settled is not the same as being well.

If they are unusually sleepy but wake and respond, report it urgently. If they are hard to wake, barely responding or can’t be roused, use the call bell and tell a nurse immediately. Ask for an emergency clinical review if there is no prompt response. Outside hospital, call local emergency services immediately.

“He is much sleepier than usual and responding far less. This is a sudden change. I am worried he is seriously unwell and needs urgent assessment for delirium.”

The doctor saw them at a good moment

Delirium comes and goes through the day, and it is often worst in the evening and at night. A person can seem reasonably clear at the morning ward round and be lost by supper. Your notes can show how the symptoms change during the day.

“I understand she seemed clear this morning. But at six o’clock she thought I was her sister and tried to pack her bag. It comes and goes, and the evenings are the worst. I have written down what happened and when. Could someone assess her later in the day, when it is usually bad?”

A new medicine, then confusion

Changes in medication are among the most common triggers of delirium. If the confusion began soon after a new drug was started or a dose was changed, report that timing, even if you have no idea whether it is the cause.

“The confusion started the day after the new tablet. Could that be connected? Could someone review her medicines?”

Falls, or not eating and drinking

Delirium brings practical dangers with it: falls, not eating, not drinking, trouble swallowing. Staff can do something about each, but often only once it is pointed out. If you see a risk, name it and ask what will be done.

“She has fallen twice at night this week. Can we talk about what would keep her safe tonight?”

“He has eaten almost nothing for three days, and there is never a drink within his reach. I am worried he is not getting enough fluid. Could the team look at this today?”

The delirium is not getting better

Recovery can be slow. If the person is not improving, ask the team to explain what they think is causing the continuing symptoms. The doctors may need to review the diagnosis, look for other causes or ask another specialist for advice.

You could say: “I understand that recovery can take time, but he is no better. Could something else be causing this? Would advice from another specialist help?”

Ask what will happen next and when you will hear the findings. Read more about review when delirium is not improving. A sudden deterioration needs medical assessment now; follow Get help now.

Weeks later, still not themselves

After the delirium has passed, recovery can be slow, and families are usually the first to notice that concentration, thinking or memory have not fully returned. Most people improve over weeks to months; some do not get all the way back. Raise it with the team rather than keeping it to yourself.

“The delirium was six weeks ago and she is still not back to herself. Is this expected? Is there anything that would help her recovery, and who should we tell if she does not keep improving?”

If you are not being heard

Not every member of staff will respond well. Knowledge of delirium is patchy and wards are pressured. Staff sometimes do not act on family concerns, saying, “he is just a bit confused”. If that happens, there is a calm order to work through.

Say it again. Explain again what has changed and why you are worried.
Move one step up. Ask to speak to the nurse in charge of the shift (charge nurse), or ask to speak to the doctor responsible for their care. In a care home or nursing home, speak to the nurse or person in charge and ask them to arrange medical assessment now rather than waiting for the next routine visit. If the person is hard to wake, barely responding or getting worse quickly, call local emergency services immediately.
Ask for your concern to be recorded. “Please could you write in the notes that I have raised a concern about possible delirium.” A concern in the notes is not lost when the shift changes.

If they are unusually sleepy but wake and respond, report it urgently. If they are hard to wake, barely responding or can’t be roused, get emergency help now. In hospital, use the call bell and tell a nurse immediately; ask for an emergency clinical review if there is no prompt response. Outside hospital, call local emergency services immediately. Ask whether your hospital has a way for families to request an urgent review when someone is getting worse and concerns have not been addressed. This may be called a family-activated rapid response. Ask staff how to request this review, or look for information on the ward or unit. See Get help now for the other emergency signs.

None of this is a formal complaint. Complaints procedures are for looking back at care that has already gone wrong; this is the opposite, an attempt to get something noticed while it can still be treated. If nothing changes and you are still worried, ask who will assess the person now. Ask a more senior member of staff for help. If the person is getting worse or is hard to wake, get emergency help now.

What families can add

Families can provide something no test or chart can: a clear account of what the person is like when well, what has changed and when. Staff who understand delirium value this information because it helps them assess the person.

Raising concerns (PDF)

The words to use, on one printable page for your pocket or the ward.

Download Raising concerns with staff (PDF)

Key points

Delirium is badly under-detected. A family raising a concern is one of the main ways it gets found.
Describe the change from normal, with times and examples, then use the word delirium and ask a direct question: “Could a doctor assess him for delirium now?”
A change over hours or days is not explained by age or by dementia.
Report unusual sleepiness urgently. If they are hard to wake or barely responding, get emergency help now.
Keep notes of what you see and when, and ask for your concern to be written in the notes.
None of this is complaining. Staff who know delirium value what families tell them.