Delirium guide for Carers

In the run up to publication of my new book Carers and Caring; the One Stop Guide; how to care for older relatives and friends I am sharing an A to Z of some of the practical solutions learned from research and experience. If you think any problems have been missed you can email me and tell me, and I’ll make sure they are covered in the next edition and online on my website at www.juneandrews.net. 

Delirium

There are some medical emergencies that obviously need first aid. Choking or bleeding are examples. However, if the person you are caring for has an abrupt change involving emotional disturbance and fluctuating mental confusion, you must call a doctor. Changes like that might not feel like an emergency , but they could be a sign of delirium, which can happen when the person is coming down with an infection or is stressed and dehydrated. In older people the cause is most commonly a chest infection or a urine infection. Make sure you tell the medics how the person normally is and that this is an unexpected deterioration from their usual state. Problem arise when they assume that the older person you care for is always like this, or has a chronic condition like dementia, and don’t investigate or try to reverse the underlying cause. Even if the person already has dementia, delirium can make them temporarily worse, so it’s good to get that reversed, making your life and theirs easier. 

If you are caring at home, it helps that the surroundings are familiar. The symptoms can be made worse by an unfamiliar environment. So if they are in hospital, you can try to recreate that familiarity by bringing in recognised personal objects and staying with the patient as much as you can. It was made possible to stay as longer if the person already has dementia, mainly as a result of the John’s Campaign, which fought to allow open-access visiting. During the COVID-19 pandemic, when that was denied, there was a clear demonstration of what happens to older people with delirium when separated from people they know. It was tragic. Making sure that they have their glasses and working hearing aid can help to reduce confusion.  

If it is possible to keep the person moving, that can help. Not least because it reduces constipation, which can make delirium worse. Remember that delirium can last for a long time. It could be months before the person gets really better, and many people die within a year. In literature delirium is often portrayed as a person who is raving, but in real life they sometimes lie quietly, drifting in and out of consciousness.

The staff said that my mum was ‘no trouble’ and sleeping most of the day. That was a warning sign for me. My mum is always trouble. If she was lying still, she must be really ill. I kept asking and they found she had a raging infection, even though there was no raised temperature. She was delirious. (Abby, daughter of Mary, 63)

Dehydration is common in settings like hospitals where it is warm and staff sometimes forget to provide fresh water or leave it within reach. Water is essential for the function of the brain and to prevent constipation, but also, more urgently delirium.  I despair at how hard it can be to support confused people to drink more in hospital.  

There is much more about delirium in  Carers and Caring: The One-Stop Guide: How to care for older relatives and friends - with tips for managing finances and accessing the right support  available from all good bookshops in May 2022

Three hints:

1.     Being suddenly more confused is not normal for older people

2.     Make sure the clinicians take it seriously

3.     Keeping hydrated helps with most things