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Elderly delirium: possible causes & treatments
Elderly delirium, or elderly confusion, is unsettling both for the person with the condition and their loved ones. It’s a state of mental confusion that comes on suddenly and can have a big impact on the way a person behaves and functions. Someone with delirium typically becomes disorientated and has difficulty concentrating.
If your loved one is suddenly suffering from confusion and a lack of awareness of their surroundings, it could be due to elderly delirium.
Delirium is usually triggered by a medical illness or the stress of hospitalisation, especially if the stay includes surgery or anaesthesia. In fact, it’s thought that 15-30% of elderly patients have delirium when they go into hospital and up to 56% develop delirium during their stay.1
This guide answers common questions about this type of condition and provides guidance on finding help. If you think your loved one has any signs or symptoms of elderly delirium, you should consult a healthcare professional as soon as possible.
If you need some support with your loved one recovering from delirium at home, our Home Care Teams can help. Our Carers can provide a reassuring presence at home, as well as physical help such as our elderly sitting services at night and assistance with using the bathroom. To learn more, find your local Team today.
What is elderly delirium?
Delirium is a serious, often sudden, change for the worst in a person’s mental abilities. It manifests as confusion and a lack of awareness of your surroundings. It can also cause drowsiness. It’s possible to confuse delirium in seniors with dementia. As a result, the input of loved ones is often useful for healthcare professionals as they try to understand a person’s condition.
What are the symptoms of delirium in seniors?
Delirium can have many different symptoms. Because of its nature, the person suffering from delirium may not even realise something has changed. This is exactly why it’s vital for loved ones and carers to keep an eye on older people and detect any changes in their demeanour.
If you suspect your elderly loved one is suffering from delirium, you should seek medical attention immediately.
Symptoms of delirium in the elderly can come on very suddenly, within just a few hours or days. They may also come and go throughout the day, and your loved one might have periods of complete lucidity.
Sometimes, symptoms will be worse at night time when it’s dark and things look unfamiliar. If this is the case, you may find your loved one would benefit from a Waking Nights Carer to reassure them in the late and early hours of the day.
Symptoms of delirium in the elderly include:
What are the three types of delirium?
There are three key types of delirium. Click the buttons below to explore the different types of delirium:
People with hyperactive delirium may be restless and agitated. They may also suffer from anxiety, mood swings and hallucinations. In these situations, they might resist personal care from a caregiver and become easily distressed. If they have these symptoms, they might also suffer from elderly paranoia.
People with hypoactive delirium can become quiet, inactive, less focused and stop eating as much. They may also experience sluggishness, drowsiness and be more withdrawn. Someone with hypoactive delirium may be less mobile than usual and spend more time in bed. As a result, it can be harder to notice hypoactive delirium than hyperactive delirium.
Mixed delirium is when people suffer from symptoms of both types of delirium described above. The person may fluctuate between symptoms of restlessness and sluggishness from one day to the next. For example, sometimes they will be agitated but at other times placid.
What are the common causes of delirium in elderly people?
Delirium happens due to something going wrong with how signals in the brain are sent and received, usually the brain’s reaction to a separate medical problem. There are several possible causes for why this happens, and sometimes multiple causes will apply to the same person. Delirium in hospitalised older adults is particularly common.
Possible causes of delirium in elderly people include:
Although anyone can get delirium, there are factors which can put people at higher risk, especially those aged over 65. These include dementia, frailty, multiple medical conditions, poor hearing or vision, taking multiple medications and brain/mood disorders.
Dementia
Dementia is the biggest risk factor for delirium; as a result, delirium can be confused with dementia. We explore the differences later in this guide.
Frailty
People over 65 are particularly susceptible to delirium. Frailty in older adults can increase the risk of falls which may then result in hospital admissions or the need for surgical procedures. Hospitalisation delirium is especially common. The person suffering from delirium may already have health issues and the unfamiliar environment, loud noises and bright lights can also exacerbate elderly confusion in hospital.
Multiple medical conditions
People with medical conditions and existing health concerns are more susceptible to delirium. In fact, the chances of developing delirium are highest in people with cancer, AIDS and terminal illness as well as those who have invasive surgical procedures such as hip replacement and cardiac surgery.2 If your loved one is recovering from surgery, they may therefore benefit from our After Hospital Care. Adjusting to living independently again after receiving continuous care and reassurance from medical professionals in the hospital can be difficult. Our Home Carers can help to ease the transition back home and assist during recovery.
Poor hearing or vision
Our senses, especially vision and hearing, help us recognise what’s happening around us. As a result, people who lack the right glasses for their vision or who rely on hearing aids may become detached from their surroundings. This can then exacerbate elderly confusion.
Brain and mood disorders
People who struggle with mood disorders such as depression are at a higher risk of developing delirium. Also, those with neurological conditions like dementia, stroke or Parkinson’s can be at a higher risk.
Taking multiple medications
Elderly people are more likely to develop cognitive impairment as a result of taking medications. Multiple medications have been associated with the development of delirium in the elderly, so a preventative factor is to avoid prescribing new medications to someone who’s at higher risk of developing the condition. The successful treatment of delirium depends on identifying contributing factors and reversing them; therefore, early diagnosis of drug-induced delirium and withdrawing medications is essential.
How are the symptoms of delirium in the elderly diagnosed?
Delirium is a sign of illness or stress on the body and mind. If a person becomes delirious, it’s important to identify the underlying problems and correct them so the person can improve and subsequently recover. According to the NHS website, delirium should be dealt with urgently. During a period of delirium, the person is at higher risk of falls, so it needs to be dealt with swiftly to avoid further injury.
While waiting for medical help, the NHS suggests:
| Do | Don’t |
|---|---|
| Stay with your loved one – reassure them by letting them know who you are and where they are | Disagree with them – if they’re saying unusual things, try to change the conversation instead |
| Keep it simple – talk calmly in short, simple and clear sentences | Ask lots of questions – keep communication simple to avoid further confusion |
| Keep an eye out – make a note and be observant so healthcare professionals can know all the details as soon as possible | Restrict movement – if your loved one is agitated, let them move about as long as they aren’t in any danger |
Once you’ve sought medical attention, a healthcare professional like a doctor or nurse can diagnose delirium. To do this, they will consider your loved one’s clinical history, including how their symptoms developed, and then examine them. They may conduct a quick test which is called a 4AT:
What is the 4AT test?
The 4AT test is used by healthcare professionals to assess delirium. The 4 As stand for:
- Alertness – is the person drowsy or agitated?
- Awareness – does the person know what year it is and where they are?
- Attention – is the person able to name the months of the year backwards from December?
- Acute change – have symptoms started suddenly or are they coming and going?
As well as diagnosing delirium, healthcare professionals may also complete tests to find out the causes of delirium in elderly loved ones. This is important because treating the causes of delirium in old age will often help the person’s symptoms to improve or cease.
Unfortunately, it can be difficult for delirium to be spotted and diagnosed. This is why it’s key for loved ones to keep an eye on elderly people, as they know them best and are more likely to notice changes.
Even though delirium is extremely common, hospitalised delirium is often missed in older adults, with some reports estimating it’s missed 70% of the time.3 Busy hospital staff may have trouble detecting whether elderly confusion in hospital is new or worse than usual. This is especially true for people who have an existing diagnosis of dementia. If you notice any changes in your loved one’s behaviour or usual state of mind, don’t be hesitant to speak up – medical professionals won’t know your loved one as well as you do so are less likely to notice.
Is it possible to prevent delirium? How is it treated?
Delirium can sometimes be prevented if your loved one gets professional medical attention. If they show signs of delirium, it’s vital to seek help as soon as possible.
The best way to prevent delirium is to target risk factors that might trigger an episode. Hospitals can be especially challenging as they often involve room changes, invasive surgeries, loud noises and bright lighting. These factors, alongside lack of natural light and poor sleep, can aggravate elderly confusion in hospital.
Here are some of the methods healthcare professionals may use to prevent delirium:
Unfortunately, prevention is not always possible. However, there are certain ways you can try to support your elderly loved one, such as:
Visiting them
Interacting with loved ones can help elderly people remain connected to their environment and therefore help prevent delirium. This is even more true if your loved one is in a hospital setting, as the chance of developing hospitalisation delirium increases significantly.
If you’re unable to visit your loved one, you could employ a Companion Carer. Our professional Carers can spend time with your loved one in their home and even help them engage in stimulating activities like days out.
Chatting with them
Conversation is a good way to avoid elderly loneliness but can also support your elderly loved one’s memory. Research proves that socialisation among older adults engages the brain and can even decrease the risk of developing dementia and Alzheimer’s.4
Focusing on familiar things
Familiar surroundings are a great way of keeping your elderly loved one calm and relaxed, which is why receiving care in the comfort of their own home is a popular choice for many people. If this isn’t possible, you could decorate your loved one’s room in a hospital or care home with familiar objects and photographs instead.
Engaging with them
Staying active is very useful when it comes to preventing delirium. Participating in elderly activities such as days out, crosswords, board games or a walk can all support your loved one. Word puzzles, jigsaw puzzles and other brain teasers can all improve cognitive function, enhance short term memory and boost concentration. In turn, this can reduce stress and improve sleep quality.5
Structuring their routine
As we age, finding a sense of purpose each day can become more challenging. You can help your elderly loved one by finding ways to structure a clear routine that supports a regular body clock. For instance, you could set up a 24 hour clock and calendar to help them keep track of the date and time. You could also help them maintain a healthy sleep routine by reducing noise and dimming the lights in their home at night time. Our Home Carers can support with this, as well as ensuring your elderly loved one regularly eats meals at the right time of day to support their body clock and routine.
What are the long term effects of delirium?
Once the underlying cause of delirium is addressed and treated, symptoms tend to improve in a matter of days or weeks. However, elderly delirium often results in longer hospital stays. When your elderly loved one is discharged and comes home from hospital, their care plan will include details to support their recovery.
Unfortunately, episodes of delirium can still have lasting consequences, and this is especially true for elderly people. A study of cardiac surgery patients aged 60+ found that delirium occurred in 46% of patients and 40% of those who’d developed delirium still had significantly lower cognitive function six months post-operation.6
Long term effects of delirium include:
Delirium and dementia
It can be difficult to tell delirium and dementia apart. They have similar symptoms, such as confusion, agitation and delusions. Your elderly loved one may suffer from both, but it can be difficult for healthcare professionals to diagnose dementia or delirium when they don’t know the person. That’s why it’s important for loved ones or their support network to recognise changes in behaviour.
Someone with dementia will have a gradual decline in memory and other cognitive skills due to damage or loss of brain cells. The most common cause of dementia is Alzheimer’s, which comes on slowly over several months or years.
Lewy Body Dementia is slightly different to other forms of dementia, as it has many of the same symptoms as delirium, including visual hallucinations. It can therefore be even harder to differentiate between the two.
Although delirium often affects people with dementia, it doesn’t always mean they have dementia. Some differences to look out for between the symptoms of dementia and delirium include:
| Delirium | Dementia | |
|---|---|---|
| How quickly does it start? | Symptoms usually appear within one or just a few days. | Minor symptoms get worse over time, such as months or years. |
| How alert is your loved one? | Affects focus, causing someone to be sluggish or agitated. | In the early stages of dementia, someone usually remains alert. |
| What happens as time goes on? | Delirium comes and goes, with periods of no symptoms. | Dementia gets progressively worse over time. |
| Is it preventable? | Many cases can be preventable. | No. |
| Can it improve? | Yes, especially when delirium is caused by a treatable factor. | No, but symptoms may be treatable. |
Is delirium a warning sign of dementia?
It’s possible delirium can be a warning sign that a person has dementia. Because of this, family members and caregivers should remain extra vigilant after a loved one experiences an episode. The sooner either condition can be identified, the sooner help can be provided.
How do you care for someone with delirium at home?
If your loved one is experiencing symptoms of elderly delirium, they may need additional help to return home from hospital. The kind of elderly help they require will vary according to their needs, as well as yours. For example, if you’re their primary caregiver, you may choose to arrange Respite Care. This involves hiring professional Carers so that you can have a regular break away from the home. Our Home Carers visit your home to provide as much or as little help as you need, ensuring continuity of care to give you peace of mind while you take a break and recuperate.
If you need more regular care, there’s a range of other care options available:
Visiting Care is available for as little or as much as you require. A Carer visits your elderly loved one’s home to provide reassurance as well as practical help. This could involve anything from making meals or sitting with your elderly loved one to helping them with using the bathroom and getting ready for bed. Our Visiting Care services can also provide help with shopping assistance if your elderly loved one is recovering from hospital admission and unable to get out and about alone.
We offer a specific Dementia Care service, where our Carers offer support and provide a calming, reassuring presence if your loved one has delirium. Our Dementia Care service is delivered by Carers in the comfort and familiarity of home. They’ll help your loved one with their needs so they can live as independently as possible for as long as possible. From preparing balanced meals to household tasks, or even just being a friendly face for a chat. Our Carers receive specialised training to help with the symptoms of dementia and the challenges your loved one faces living with the condition.
If your elderly loved one has delirium, it’s highly likely their care needs will increase. Live-in Care involves a Carer moving into the home to provide support throughout the day and night. This means you have continuous reassurance, which is especially helpful if your elderly loved one is irritable or suffers from hallucinations during the night. Our Carers can help pacify your loved one and discern between their genuine concerns and their paranoid beliefs. Our care is focused on maintaining dignity and always delivered with sensitivity and compassion.
Elderly delirium can be prevented and supported by a healthy and regular sleep routine. If your loved one needs some added reassurance during the night time, our Overnight Care service could help. With Waking Nights, one of our Carers stays awake throughout the night to watch your elderly loved one. They can help them with using the bathroom in the late or early hours of the day, as well as providing reassurance if your loved one wakes up agitated from their sleep. With Sleeping Nights, a Carer sleeps in the home but is always available if or when help is needed.
1. National Library of Medicine, “Delirium in the Elderly: A Review”, Reviewed 16 November 2023
2. National Library of Medicine, “Delirium in the Elderly: A Review”, Reviewed 16 November 2023
3. Better Health While Aging, “10 Things to Know About Delirium”, Reviewed 16 November 2023
4. Whitney Centre, “Psychological Benefits of Socialization for Aging Adults”, Reviewed 16 November 2023
5. Terra Bella Senior Living, “5 Benefits of Playing Puzzles for Seniors”, Reviewed 16 November 2023
6. National Library of Medicine, “Cognitive Trajectories After Postoperative Delirium”, 16 November 2023
7. National Library of Medicine, “Delirium in the Elderly: A Review”, Reviewed 16 November 2023
8. National Library of Medicine, “Delirium in the Elderly: A Review”, Reviewed 16 November 2023
9. NHS, “The Delirium Recovery Programme (DRP): Pilot study of Cognitive Enablement at Home following hospital admission”, Reviewed 16 November 2023
10. National Library of Medicine, “Delirium in the Elderly: A Review”, Reviewed 16 November 2023
11. National Library of Medicine, “Delirium in the Elderly: A Review”, Reviewed 16 November 2023
12. National Library of Medicine, “Delirium in the Elderly: A Review”, Reviewed 16 November 2023
13. British Geriatrics Society, “End of Life Care in Frailty: Delirium”, Reviewed 16 November 2023