Delirium - Diagnosis and Treatment

Diagnosing Delirium

Diagnosing delirium involves a careful review of medical history and a series of assessments.

Healthcare providers look for sudden changes in mental abilities, especially confusion, memory problems, or disorganized thinking.

They may ask about recent infections, new medications, drug or alcohol use, pain, or injury that could have triggered symptoms.

Key steps in evaluating delirium include:

Checking Mental Function: Providers test awareness, attention, and thinking by asking questions or using short screening tests. Family members can offer extra details about any behavior changes.
Physical Examination: The provider looks for signs of medical illness or health changes, checking for fever, dehydration, or severe pain. The provider also conducts a neurological exam, testing vision, balance, movement, and reflexes. This helps rule out conditions like stroke, meningitis, or head trauma.
Laboratory Tests: Blood or urine tests help find causes such as infections, electrolyte imbalances, poisoning, or advanced cancer.
Imaging tests: Sometimes, providers order brain scans if they cannot determine the cause.

Providers often use the Confusion Assessment Method (CAM) to check for cognitive impairment, altered consciousness, hallucinations, or perceptual disturbances.

Health care providers also identify different types of delirium, such as hyperactive delirium or delirium tremens, to help guide care.

Treatment

Basic Support and Monitoring

Supportive care focuses on creating a safe and calm environment to help patients recover. Providers make sure the person has enough fluids and nutrition, keep the airway open, and manage pain.

They encourage movement when possible to avoid complications from staying in bed too long. Providers address bladder control issues carefully, avoiding bladder tubes when not necessary.

They limit sudden changes in surroundings or caregivers, as stability helps with orientation. Family members or familiar people offer comfort and help reduce confusion. Providers avoid using restraints unless absolutely necessary because restraints can worsen symptoms.

Supportive Care Table

Action	Purpose
Maintain hydration & nutrition	Prevents complications
Manage pain	Improves comfort
Encourage mobility	Reduces risk of immobility issues
Avoid restraints	Lessens agitation
Consistency in care	Reduces confusion

Use of Medicines

Providers consider medicines only when symptoms are severe or put the patient or others at risk. Adjusting or stopping certain drugs can help improve delirium.

Health professionals review all current medicines, especially psychoactive medication, antipsychotics, or sedatives that could make delirium worse.

If supportive steps do not control symptoms like agitation or hallucinations, providers may use medications such as antipsychotic drugs.

Providers sometimes choose haloperidol and other antipsychotics for short-term control. In rare cases, they use benzodiazepines mostly when delirium is related to withdrawal. Providers adjust or stop medicines as soon as symptoms improve.

Common Medications Table

Medication Type	Used For
Antipsychotics	Severe agitation, psychosis
Benzodiazepines	Withdrawal-related delirium
Pain relievers	Pain control

Providers do not use medications as a first line but may need them in the emergency department or intensive care settings for certain hospitalized patients when risks are high. Providers aim for the shortest effective course and careful monitoring.

Ways to Offer Support and Cope

Encouraging Healthy Sleep Routines

Maintaining healthy sleep routines can make a big difference, especially for older adults or those at risk of delirium. Create a peaceful and quiet space for sleep.

Use lights indoors that match the time of day to support a normal sleep-wake cycle.

Keep a regular daytime schedule with gentle activity and self-care to prevent late-day sleep, which often disrupts night rest. At night, limit noise and bright lights so the person can sleep without being disturbed.

Helpful Sleep Tips	Notes
Quiet, calm room	Reduces sleep problems
Proper lighting based on time of day	Supports natural rhythms
Daytime routines and gentle activity	Prevents daytime naps
Limit nighttime noise and activity	Encourages restful sleep

Supporting Calmness and Awareness

Help the person stay calm and aware of where they are, especially for those with sensory problems or memory loss. Keep a clock and calendar nearby, and talk about the day’s events to keep them oriented.

Familiar objects and photos can offer comfort, but avoid crowding the area. Approach calmly and introduce yourself when needed. Provide glasses and hearing aids to reduce confusion and help with orientation.

Reduce loud noises and distractions to create a safe and calming atmosphere.

Place visual aids like clocks and calendars in sight.
Use a caring tone and avoid arguments.
Allow access to familiar items (photos, blankets).
Make sure glasses and hearing aids are with the person.

Stopping Other Health Problems

Prevent other health problems by giving medicines on schedule and watching for infections or issues that may appear. Encourage drinking water and having a balanced diet to support overall health and prevent dehydration.

Gentle physical activity every day helps prevent functional decline and frailty. Get prompt medical help when needed to reduce the chances of complications.

Stick to medicine and nutrition schedules.
Provide plenty of fluids.
Invite light exercise.
Watch for symptoms and act quickly.

Taking Care of the Caregiver

Caregivers need support too. Dealing with delirium can be tiring and stressful for family or nursing staff. Join caregiver groups or seek trusted resources.

Take breaks and share duties with others. Caregivers should also learn more about delirium and look after their own health with proper rest and nutrition. Seek community help or talk with support organizations for relief and guidance.

Caregiver Support Resources:

Local community health services
Family, friends, and caregiver groups
National organizations for elderly patient care

Getting Ready for Your Visit

Steps You Can Take

Before the appointment, gather important details about the person’s health. Write down all medications the person uses, including prescriptions, over-the-counter drugs, and supplements. Be sure to record the doses and any recent changes in their routine.

Organize the contact information for anyone involved in the person’s care, such as home care aides or family members who help regularly.

List the symptoms you have noticed, along with when they started. Include any changes in mood or behavior, like confusion, pain, fever, or cough.

Bring a list of questions for the health care provider. These could be about possible causes, treatment options, or ways to lower risk.

It’s also useful to have a brief medical history ready. Note any risk factors, such as other illnesses, past injuries, or situations that might make delirium more likely.

Sample Checklist for Your Appointment

What to Bring	Details to Include
Medication list	All current medicines, recent changes, dosages
Caregiver contact info	Names, phone numbers, roles of caregivers
Symptom tracker	Start dates, details, changes before delirium started
Recent health events	Infections, injury, changes in mood or sleep
Medical background	Chronic illnesses, risk factors, predisposing factors
Appointment questions	Concerns, next steps, support needs

What the Provider Will Likely Ask

The doctor or nurse will ask about the person’s current symptoms, when they started, and if the person recently had health problems like infections, falls, or pain.

They will want to know about the person’s memory and thinking before these symptoms began and whether the person managed daily tasks independently.

Delirium – Diagnosis and Treatment