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Learning to identify hospital delirium

Last Modified: January 31, 2023

Diseases & Disorders


For patients and their loved ones, a sudden onset of confusion during a hospitalization can be alarming. As Lindy Bilimek MSN, RN, AGCNS-BC, geriatric clinical nurse specialist, Carew MedSurg, 4 and 5 Medical, Parkview Hospital Randallia, and Kellie Girardot, MSN, RN, AGCNS-BC, Trauma and Emergency Department Clinical Nurse Specialist, explain, this is most often a temporary diagnosis, known as hospital delirium. They educate readers on the many factors that contribute to this condition, and what families can do to help their loved one stay oriented during a hospital stay.  

What is hospital delirium?

Delirium is a common problem, causing sudden confusion and changes in mental function. Experts think delirium is caused by a change in the way the brain is working, potentially triggered by:

  • Infection
  • Severe pain
  • Serious illness
  • Certain medications (especially benzodiazepines and opioids)
  • Lack of adequate sleep
  • Withdrawal from drugs or alcohol
  • Dehydration
  • Sedation (deep and/or prolonged)
What are the signs and symptoms of hospital delirium?

The symptoms of delirium vary from person to person and tend to fluctuate throughout the day. People with delirium …

  • Cannot think clearly
  • Have difficulty paying attention
  • May see or hear things that aren’t there
  • May become quiet or withdrawn
  • May act restless, upset or agitated
Who is at the greatest risk of hospital delirium?

Delirium can often be traced back to multiple causes. It can occur in all age groups, but is more common in people who:

  • Are of advanced age
  • Have dementia or depression
  • Have poor eyesight or difficulty hearing
  • Recently had surgery, especially on their hip or heart
  • Have a history of delirium
  • Have decreased mobility, dehydration or malnutrition
Is hospital delirium dangerous?

Patients with delirium often experience longer hospitalizations and are at higher risk of poor outcomes, such as pressure injuries and falls. In addition, delirium can be distressing for the patient and family. Delirium can have lasting effects on the patient, even after they are discharged from the hospital.

How can loved ones help prevent and treat delirium?

Not all delirium can be prevented, but there are things that can reduce the risk of developing the condition while in the hospital.  If your loved one is in the hospital, you can help by:  

  • Bringing the patient’s glasses, hearing aids and dentures
  • Visiting with the patient to help keep them alert and active during the day
  • Bringing in a familiar item from home, such as a blanket or family photo
  • Notifying the health care team if you notice any symptoms of delirium

If delirium has set in, family can help their loved one recover from delirium by:

  • Placing a photo or familiar object nearby for the patient to see
  • Encouraging the patient to get up and sit in a chair during the day (if possible)
  • Making sure the patient has their glasses, hearing aids or both
  • Helping the patient stay active and alert during the day
  • Talking about family, friends or familiar topics
Is hospital delirium often confused with other neurological conditions? If so, how can loved ones differentiate?  

The symptoms of delirium can be confused with dementia, however, they are two very distinct conditions. Delirium starts suddenly and the symptoms tend to fluctuate throughout the day. It typically lasts a few days to weeks and is reversible when the underlying cause is treated. 

Dementia, on the other hand, progresses over months to years, and is typically permanent and incurable. It’s possible for a patient with dementia to experience delirium as well, so loved ones should share any sudden changes in mental status with the patient’s healthcare team.


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