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Delirium is very common in patients with advanced illness. With delirium, patients have periods in which they are suddenly confused and unaware of what is going on around them. They may become agitated and restless or withdrawn. Delirium can be very upsetting for family members to witness. If your loved one develops signs of delirium, let his or her doctor know right away. In some cases, the cause of the delirium can be treated. In others, steps can be taken to help manage delirium and ensure your loved one’s safety and comfort.
Delirium often has multiple causes. These can include:
Serious or terminal illness
Drug and alcohol abuse
Other problems such as anemia or nutrition deficiency
There are two main types of delirium: hypoactive and hyperactive. Patients can have one or both types. In a hypoactive state, patients are sleepy and withdrawn. They may show little interest in their surroundings. In a hyperactive state, patients are excitable and agitated. They may become violent. And they may believe in or see things that aren’t there. Most patients with delirium will also have the following symptoms:
Changes in sleep patterns
Confusion about time and place (disorientation)
Problems with memory and speech
Changes in mood or personality
Your loved one’s doctor and healthcare team will try to identify the cause of the delirium and treat it, if possible. Sometimes, the cause cannot be found. Or treatment may be available, but it may be too much of a burden at this point in their illness. In such cases, the main goal of treatment is to manage the delirium and keep your loved one safe and comfortable. You may be told to do the following:
Provide safe and familiar surroundings. Keep your loved one’s room clean and well-lit. Have familiar objects nearby, such as a favorite blanket and family photos. Add a clock next to the patient’s bed and a calendar on the wall to help your loved one keep track of time.
Limit contact with strangers. Try to ensure that your loved one receives care from the same healthcare providers or caregivers. Keep visitors restricted to family members or close friends to reduce confusion.
Maintain a regular day and night schedule. During the day, open blinds and windows or keep the lights on to encourage your loved one to stay awake and alert. During the night, dim the lights and keep noise levels low to encourage sleep.
Expect sudden changes in behavior. There may be times when your loved one is normal and alert. But other times he or she is not fully present. Your loved one may forget who you are. He or she may also imagine things or speak to people who aren’t there. Try to stay calm during these episodes. It may help to provide a gentle touch or reassuring words. Or you may choose not to speak and simply listen.
Use positive language. Try not to raise your voice or argue with your loved one. Keep conversations simple. If your loved one is confused, state simply and calmly where he or she is and what is going on.
Avoid the use of restraints. These can make a person more anxious, afraid, or angry and increase confusion. If needed, arrange for a 24-hour caregiver or nurse, so your loved one is never left alone. Or take turns sitting next to the patient’s bedside with other family members and friends.
Alert the doctor if your loved one’s delirium worsens. If needed, medications can be prescribed to help your loved one sleep or stay calm.
Treatment of delirium may change when your loved one is near death. The doctor and healthcare team can help prepare you for what to expect in the last days of life. If delirium is severe, ask the doctor about options for keeping your loved one comfortable. Don’t be afraid to ask questions or seek help at this time. If more support is needed, other healthcare team members, such as a social worker or spiritual advisor, can help.