Delirium occurs in 20% to 25% of hospitalisations annually and is the most common hospital-related complication in the US. [5] Brown TM, Boyle MF. Delirium. BMJ. 2002 Sep 21;325(7365):644-7. Delirium indicates a widespread disruption in brain activity. That means there are many possible symptoms of delirium. It’s also important to remember the symptoms may look different from one person to the next. It can also fluctuate. Delirium can often get better during the day and worse as nighttime approaches, which is why this condition sometimes gets the incorrect name of “sundowning.”

Mixed delirium. This delirium includes symptoms of both hyperactive and hypoactive delirium and the individual can switch rapidly between hyperactive to hypoactive states. Some people may become paranoid (suspicious) and mistrustful of the people around them. These thoughts can sometimes become distressing. John, a retired teacher, was admitted to hospital after he broke his leg. A few days after his surgery his physiotherapist noticed that he seemed reluctant to work with her. The nurses on the ward noticed that his appetite was poor and that he wasn’t drinking enough – they wondered if he had become depressed. A blood test showed that his kidneys weren’t working as well as they should. A specialist nurse noticed that he did not know where he was or why he was there, and that he could not pay attention to their conversation. Delirium is a state of mental confusion that starts suddenly and is caused by a physical condition of some sort. You don’t know where you are, what time it is, or what’s happening to you. It is also called an 'acute confusional state'. We try to make sure that people get the right level of support when they leave hospital. This includes rehabilitation to improve, restore and maintain their everyday skills and mobility.

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Make natural lighting a priority. Using natural light during the daytime and providing enough darkness at night help your body’s natural timing stay accurate. Staying oriented to the time of day can be a big help in preventing delirium. Some patients may hallucinate or have delusions. The deterioration of mental faculties might affect their understanding of their surroundings and situation, which can make it very frightening for them. Using the Bolton Pain Scale to assess non-verbal signs such as facial expressions and how they are holding their body we will make sure that they are not in pain. Your feet and hands may feel cold because of changes in your circulation. Blankets over your hands and feet can keep you warm.

Francis J Jr. Delirium and acute confusional states: Prevention, treatment, and prognosis. https://www.uptodate.com/contents/search. Accessed Sept. 19, 2022. If someone suddenly develops any of the symptoms below or is ‘not themselves’, speak to a nurse or doctor immediately. Family, friends and carers – including professional carers – are often best placed to recognise and describe changes because they know the person best. A person with delirium may be unaware of the changes and will often be unable to describe them. Marcantonio ER, Simon SE, Bergmann MA, et al. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. J Am Geriatr Soc. 2003 Jan;51(1):4-9.

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The short-term consequences are that patients with delirium are more likely to spend longer on a breathing machine. They are more likely to get chest infections, bed sores, or clots – and as a result of that they spend more time in intensive/critical care. Janssen TL, Alberts AR, Hooft L, et al. Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis. Clin Interv Aging. 2019;14:1095-117. Hyperactive delirium. This is probably the most easily recognised type of delirium and you would expect to see the person being very restlessness (pacing around), becoming agitation, having rapid mood changes and possibly experiencing hallucinations (experiencing sights, sounds, smells, tastes or physical sensations that do not exist outside the persons mind) or delusions (a belief that is held with strong conviction even when presented with evidence to the contrary). Family members and carers are often the first to notice small changes. We've included quotes from family members describing behaviour and symptoms of delirium. This might help you to recognise symptoms. Disorientation

Delirium is common in older people in hospital, because they are unwell or may have had an operation (for example, hip or heart surgery). Hospital staff should speak to the patient and family beforehand about the risk of delirium after the operation. Intensive care is another very common cause of delirium in hospital.Ghaeli P, Shahhatami F, Mojtahed Zade M, Mohammadi M, Arbabi M. Preventive intervention to prevent delirium in patients hospitalized in intensive care unit. Iran J Psychiatry. 2018;13(2):142-147. PMID: 29997660 While delirium is temporary, the effects and symptoms can sometimes linger. This is especially true when delirium is severe or goes untreated. However, even with treatment, the effects can be long-lasting. Because of that, the best way to manage delirium is to prevent it from ever happening (or at least to limit the effects). How long delirium lasts Your family and carers may find it upsetting or worrying if you do not eat, especially if they see you losing weight, but they do not need to make you eat. The disturbance develops over a short period of time (usually hours to days), represents an acute change from baseline, and tends to fluctuate during the course of the day.