Hospital delirium is a temporary but serious condition. It typically affects older adults who are unwell, especially those with dementia.

Hospital delirium is a challenging condition affecting many individuals during their hospital or clinic stay. It causes sudden confusion, emotional upsets, and behavioral changes. Although usually temporary, it can lead to worse outcomes, prolonged hospitalizations, and increased healthcare costs.

Although anyone can develop hospital delirium, it tends to affect older adults. Around one-third of patients aged 70 or older have delirium — and it is the most common surgical complication among older adults.

This article explores hospital delirium, its signs, causes, and treatment. It also answers some frequently asked questions about the condition.

People holding hands in a hospitalShare on Pinterest
sturti/Getty Images

Hospital delirium develops when a person is in hospital or shortly before. Delirium affects cognition, or a person’s mental state, causing changes in consciousness, perceptions, attention, and mood.

Some common symptoms of delirium include changes to:

  • Attention: A person may find it challenging to focus or answer questions. They may be distracted easily.
  • Awareness: The individual may be withdrawn, agitated, paranoid, or have hallucinations.
  • Cognition: A person has altered thought processes, leading to confusion and disorientation. They may also have difficulty speaking, remembering, or with daily activities.

A person may also experience:

  • difficulty sleeping
  • mood and personality changes
  • restlessness

A combination of factors can cause hospital delirium. Some risk factors include older age or preexisting cognitive impairments, such as dementia.

Other potential contributing factors include:

  • pain
  • underlying medical conditions, particularly infections, metabolic imbalances, and organ failures
  • surgery
  • mental health conditions, such as anxiety and depression
  • medication side effects

Environmental factors, such as unfamiliar surroundings and sleep disturbances, may also play a role. Hospital delirium tends to be higher for people in intensive care units (ICU) or those requiring mechanical ventilation.

Hospital delirium is distressing and can seriously affect a person’s outlook.

Experts associate it with the following:

  • prolonged hospital stays
  • increased risk of complications, such as hospital-acquired infections
  • functional decline
  • higher mortality rates

Delirium does share a link with dementia. People who develop hospital delirium might have an increased risk of developing dementia later in life.

Treating hospital delirium aims to address underlying causes and manage symptoms. A crucial step is identifying and treating any medical issues, such as infections, electrolyte imbalances, or medication-related issues.

The healthcare team can help by ensuring the person’s environment:

  • promotes sleep
  • reduces sensory overload
  • enhances orientation

Supportive care may also focus on adapting standard approaches, for example, avoiding physical restraints or urinary catheters (if possible).

Doctors may also prescribe medications to help ease agitation, restlessness, or hallucinations.

Supporting an individual to limit or avoid hospital delirium requires a collaborative effort from healthcare professionals, caregivers, and the individual.

Here are some practical steps:

  • Encourage orientation: Help the person stay oriented to their surroundings by placing familiar objects in their environment and providing regular updates about the date, time, and location.
  • Maintain sleep routine: Ensure the individual’s sleep-wake cycle is consistent. Dim the lights during nighttime and encourage daytime activity to promote restful sleep.
  • Stay hydrated and nourished: Encourage a balanced diet and regular fluid intake to prevent dehydration and nutrient deficiencies that can exacerbate delirium.
  • Promote social interaction: Encourage social engagement, whether through conversations, visits from loved ones, or participation in group activities.
  • Create a calm environment: Reduce noise, ensure proper lighting, and minimize disruptions to create a relaxed and reassuring atmosphere.
  • Support sensory stimulation: Provide sensory stimuli such as familiar music, photographs, or tactile objects to help maintain cognitive engagement.
  • Communicate with healthcare providers: Keep an open line of communication with the medical team, promptly sharing observations of any changes in behavior or cognition.
  • Be patient and compassionate: Individuals experiencing delirium may become frustrated or agitated. Maintain a patient and empathetic demeanor while providing reassurance and support.

Below are some commonly asked questions about hospital delirium:

Does hospital delirium go away?

Yes, hospital delirium often resolves once doctors manage the underlying factors that triggered it.

However, residual cognitive deficits might linger even after delirium subsides for some individuals — especially those with preexisting cognitive impairments or severe medical conditions.

How long does delirium last in older people?

The duration of delirium varies widely depending on the following:

  • the individual’s overall health
  • underlying causes
  • effectiveness of treatment

In some cases, delirium may resolve within a week or two once the care teams have addressed the contributing factors. Still, it can have a longer-lasting impact.

In older individuals or those with complex medical conditions, delirium might persist longer, and cognitive recovery could take weeks to months.

Can delirium be fatal?

While delirium is not typically fatal, underlying causes and associated complications can lead to adverse outcomes, especially in vulnerable older people.

Delirium can lead to:

In severe cases, delirium might contribute to a decline in overall health, potentially leading to increased mortality rates, particularly when coupled with other severe medical conditions.

Hospital delirium causes changes in a person’s thoughts, mood, behavior, and attention. It develops in unwell people in hospitals or shortly before their admission. Those most at risk are older individuals with pre-existing cognitive issues. Treatment aims to address the underlying causes and can include medications to ease distressing symptoms.

Caregivers and healthcare professionals can limit the impact of hospital dementia through familiarity, communication, and tailored interventions. A team effort to create an environment that nurtures cognitive well-being can lead to improved outcomes, enhanced recovery, and a greater quality of life for those navigating hospital care.