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Delirium

Diseases
3 November 2025

Delirium is a condition of acute confusion accompanying a severe illness or an extreme medical condition, which characterizes older adults.

It is important to examine the symptoms and make a diagnosis as early as possible, and at the same time treat the symptoms of the acute confusion that may endanger those who suffer from it. Among the possible causes of delirium are:

  • Infections such as urinary tract infections.
  • Constipation or urinary retention.
  • Abrupt discontinuation of medication.
  • Effect of anesthetics in surgery.
  • Effect of drugs or alcohol.

Delirium is a serious diagnosis that increases the risk of experiencing it again.

Delirium is characterized by waves; the patient can wake up and look perfectly fine, but at night the confusion may return. Therefore, if a patient underwent an inpatient surgical procedure, was discharged home, and after a few days feels confused, it is important to check the symptoms and diagnose as early as possible, partly because sometimes delirium exposes hidden dementia or worsens it.

The treatment of delirium includes:

  • Creating a calm and supportive environment.
  • Ensuring that there is always someone by the patient's side to reassure and treat if necessary.
  • Drug treatment, which is adjusted according to the degree of cooperation of the patient. It is important to know that the drugs for confusion are antipsychotic medications and have many side effects. Therefore, it is important to use them in doses as low as possible and only according to the exact instructions of the treating physician.

Delirium is a sudden state of confusion that often occurs with serious illnesses, especially in older adults. It can be hard to diagnose and requires immediate medical care. Sometimes, delirium can reveal an underlying dementia or make it worse, so it’s important to understand that delirium is a serious issue. If someone is diagnosed with delirium, there is a significant

Underlying causes of delirium

Delirium has a physical cause that should be identified quickly to treat the symptoms of confusion. Some possible causes include:

  • Problems with salt absorption due to dehydration or other issues.
  • Infections, like urinary tract infections.
  • Constipation or urinary retention.
  • Stopping medications abruptly that should be reduced gradually.
  • Effects of anesthesia after surgery.
  • Metabolic disorders, such as too much or too little calcium in the body.
  • Severe or long-lasting pain, like after surgery or due to an infection.
  • Changes in the surroundings of dementia patients.

How to diagnose delirium

To relieve delirium symptoms, early diagnosis is crucial. This includes distinguishing delirium from "sundowning," which affects dementia patients at sunset, or rare neurological conditions.

Diagnosis is done using the CAM method (Confusion Assessment Method), which involves examining the following:

  • Fluctuating symptoms: Symptoms come and go quickly, often within hours or days. Patients may seem clear-headed at times and confused at others.
  • Attention issues: Significant attention problems can be confirmed by asking the person to perform a simple task, like naming the days of the week backward.
  • Disorganized thinking: Conversations may lack consistency, with thoughts jumping around abruptly.
  • Altered consciousness: The patient may be agitated, lethargic, or seem indifferent to their surroundings.

Note: To diagnose delirium, criteria 1 and 2 must occur along with either criterion 3 or 4, or both.

In intensive care, additional diagnostic tools like CAM-ICU may be used.

Tests after diagnosing delirium

Once delirium is diagnosed, several tests are needed to find the underlying medical issue:

  • Check temperature, pulse, blood pressure, blood oxygen levels, pain, constipation, and urinary retention.
  • Blood tests may be necessary to diagnose the acute condition.
  • Imaging tests, like CT scans or ultrasounds, may be needed based on the patient’s condition.

Treating delirium

Treatment for delirium focuses on the patient’s overall health. While doctors work to identify the cause of delirium, they also need to help ease the patient's confusion:

  • Calm environment: Family should provide a peaceful and supportive atmosphere, including ensuring the patient eats and drinks if possible.
  • Avoid leaving the patient alone: A family member should stay with the patient for reassurance and assistance.
  • Post-surgery confusion: Patients may feel fine in the morning but confused at night. Those recently discharged after surgery may still experience confusion and need ongoing medical support.

Recognizing the initial symptoms of delirium quickly may not lead to immediate treatment. Confusion can last several weeks, improving gradually.

Medication for delirium

Sometimes, confusion comes with self-harming behavior, like trying to get out of bed after surgery. If family or caregivers cannot manage these behaviors, medication may be needed.

Medications to relieve confusion are usually antipsychotics and can have side effects, so it’s important to use the lowest dose possible and follow the family doctor’s instructions.

  • For cooperative patients: Oral medications can be given in pill or liquid form.
  • For uncooperative patients: Injectable medications may be necessary if self-harming behavior escalates.

Can delirium be prevented?

Preventing delirium is the best approach when possible. As we age, even small imbalances can be hard to correct. Here are some preventive measures:

  • Be prepared: Family members should be ready for potential confusion, recognize it as a sign of a problem, and seek medical evaluation quickly.
  • Stay hydrated: It’s important to drink enough water and discuss hydration with the family doctor.
  • Manage pain with appropriate medications.
  • Prevent digestive issues: Address constipation or urinary retention.
  • Encourage mobility: For hospitalized patients, maintaining movement is crucial to prevent complications like delirium. If there are no medical restrictions, caregivers or family should encourage movement.