Understanding delirium

Your mother, normally sharp, is struggling to follow the conversation, and is saying odd, puzzling things. Or your husband, recovering in hospital the day after a routine operation, is confused and anxious, and is insisting that the staff are not to be trusted and that he be taken home to safety.

This rapid and unsettling change is very often a condition called delirium.

Delirium is a sudden deterioration in a person’s mental functioning. This deterioration can take several forms including becoming obviously confused, being very sleepy and less responsive or being agitated, anxious, seeing things that are not real, or believing odd things.

A common phrase used to describe this is ‘They are not themselves.’

Delirium appears suddenly, within hours or days. This is very different from dementia, which arises slowly over months or years.

Delirium is a sign that the brain is under stress and that its functioning is disrupted. It is usually caused by a physical illness like an infection, an injury or a change in medication, but sometimes, in the most vulnerable, simply because of a change in environment or routine.

Delirium is a medical emergency. Recognising it quickly really matters, because treating the cause early can make the delirium less severe and speed up recovery.

Although delirium is very common, affecting about one in four older people admitted to hospital, many people have never heard of it. Or they are aware that an infection can lead to confusion, but they do not know that the official term for this is delirium.

Unfortunately, some healthcare professionals still miss delirium, or misdiagnose it because its symptoms appear similar to other conditions. Also, even if a sudden change in mental functioning is recognised by staff, delirium is often given other names, like ‘post-operative confusion’ or it is simply put down to old age.

Not using the specific word ‘delirium’ makes it much more difficult for families and those experiencing delirium to understand what’s happening.

What is the aim of this book?

We are doctors with many years of experience of looking after people with delirium. We have written this book to provide a clear, helpful guide to understanding and managing delirium. Our motivations come from knowing that many families and individuals affected by delirium lack clear information and explanation.

As well as providing delirium care as a doctor for many years, co-author Dr Sharmella Summan also personally experienced highly distressing delirium whilst unwell in the Intensive Care Unit. This further drove her to help families and individuals to understand more about the condition. Sharmella gives an account of her delirium later in the book.

In this first chapter, we provide an overview of delirium. Later chapters will give you more detail on the causes, detection and treatment of delirium. Our aim is to help you feel more confident about the facts, and to give practical advice and reassurance at a time that can feel very uncertain.

In writing this, we’ve drawn from our experience in caring for people with delirium as well as from many conversations with many families who’ve supported loved ones through this difficult condition. We’ve also drawn on recent research, and on patients’ own written and spoken accounts of their delirium.