Delirium
Delirium is a confused mental state that includes changes in
awareness, thinking, judgment, sleeping patterns, as well as behavior.
Although delirium can happen at the end of life, many episodes of
delirium are caused by medicine or dehydration and are reversible.
The symptoms of delirium usually occur suddenly (within hours
or days) over a short period of time and may come and go. Although
delirium may be mistaken for depression or dementia,
these conditions are different and have different treatments.
Types of Delirium
The three main types of delirium include:
- Hypoactive delirium: The patient seems
sleepy, tired, or depressed
- Hyperactive delirium: The patient is
restless, anxious, or suddenly agitated
and uncooperative
- Mixed delirium: The patient changes back
and forth between hypoactive delirium and hyperactive delirium
Causes of Delirium
Your health care team will work to find out what is causing
delirium, so that it can be treated. Causes of delirium may include:
- advanced cancer
- older age
- brain tumors
- dehydration
- infection
- taking certain medicines, such as high doses of opioids
- withdrawal from or stopping certain medicines
Early monitoring of someone with these risk factors for delirium
may prevent it or allow it to be treated more quickly.
Changes caused by delirium can be upsetting for family members
and dangerous to the person with cancer, especially if judgment is
affected. People with delirium may be more likely to fall, unable to
control their bladder and/or bowels, and more likely to become
dehydrated. Their confused state may make it difficult to talk with
others about their needs and make decisions about care. Family members
may need to be more involved in decision-making.
Ways to Treat
Steps that can be taken to treat symptoms related to delirium
include:
- Treat the causes of delirium: If
medicines are causing delirium, then reducing the dose or stopping them
may treat delirium. If conditions such as dehydration, poor nutrition,
and infections are causing the delirium, then treating these may help.
- Control surroundings: If the symptoms of
delirium are mild, it may help to keep the room quiet and well lit,
with a clock or calendar and familiar possessions. Having family
members around and keeping the same caregivers, as much as possible,
may also help.
- Consider medicines: Medicines
are sometimes given to treat the symptoms of delirium. However, these
medicines have serious side effects and patients receiving them require
careful observation by a doctor.
- Sometimes sedation may help: After
discussion with family members, sedation
is sometimes used for delirium at the end of life, if it does not get
better with other treatments. The doctor will discuss the decisions
involved in using sedation to treat delirium with the family.
Talking with Your Family Member's Health
Care Team
Prepare for the visit by making a list of questions to ask.
Consider adding these questions to your list:
- Is my family member at risk for delirium?
- What is causing the delirium?
- What problems should we call you about?
- What treatments are advised for my family member?
-NIH