Delirium in adult critical care: general information

This leaflet will provide you with general information about delirium and how it may present itself. You have been given this leaflet as your relative has been identified as having delirium during their stay on the critical care unit.

About delirium

What is delirium?

Delirium is a sudden change in a person’s state of mind, also known as an ‘acute confusion’. This confusion can fluctuate. The person may be either more sleepy during the day or hyper-vigilant/hyperactive. They may have difficulty paying attention, be disoriented and/or have disorganized thinking.

It is reported that up to 80% of critical care patients can develop delirium during their stay. There are several reasons why your relative may be experiencing delirium including: medications, infection, dehydration/malnutrition, pain, being in an unfamiliar place and sleep deprivation. Delirium can be distressing for patients and relatives; you can seek support from staff to talk through any questions or concerns you may have.

It is important to highlight that delirium is different from brain injury and dementia although some of the symptoms may look similar. For those with delirium we would expect symptoms to be temporary and usually improve in a few days or weeks. However, some people may continue to experience delirium for several months.

Types of delirium

There are three different types of delirium. The most common of these is hypoactive delirium. People with hypoactive delirium tend to be withdrawn and quiet. They are often very sleepy and lack interest in what is going on around them.

The least common type is hyperactive delirium. People with this type of delirium are often agitated and can be aggressive at times. They may also experience hallucinations and delusions.

The other type is mixed delirium, which involves alternating between hyperactive and hypoactive.

There can be many levels of delirium. Some people have mild delirium with minimal symptoms and slight disorientation. Others may experience some extreme symptoms and be very unsettled and disorientated.

What are the symptoms of delirium?

It is normal for people to have different symptoms; these vary for each individual.

Attention

Some people with delirium have difficulties with concentration such as being unable to follow a conversation they were having with their relative or feeling unable to speak clearly. They may respond to conversation with unrelated responses. They may be unable to form complete sentences, or may say the same phrase repeatedly.

Disorientation

A lot of people subject to delirium describe being generally confused about where they are and the situation they are in. Some people are not aware they are in hospital but think they are at home or even a hotel. They may not able to recall the correct date or time of day, or may think they are in another hospital or city. Some people may not be aware that they are unwell, or that they cannot walk or perform the day-to-day tasks they used to before admission to critical care. Those who have hyperactive delirium may try to get out of bed to go to the toilet without assistance and are at increased risk of falling.

Memory

Delirium often affects memory. Some people may not be able to recall events that led to their hospital admission. They may have difficulty recalling what they have done during the day. They may also have difficulty recalling conversations with hospital staff and family members and even forget that they have seen or spoken to people that day.

Altered Sleep-wake cycle

Delirium sufferers often sleep at random times during the day and may be wide awake at night. They may try to call family members at night time, as they do not recognize what time it is. They may also try to sleep through family visits.

Behaviour

Behaviour changes are common for patients with delirium. It is normal for relatives to find this difficult to manage. Some people may try to pull out attachments, shout out for help or frequently try to get out of bed. They may become very anxious, tearful or withdrawn. They may feel upset towards their family members for not taking them home.

Hallucinations and delusions

It’s not uncommon for delirium to cause people to experience visual or auditory hallucinations and delusions. These feelings are very vivid and very real for the person experiencing them. Common hallucinations people may experience include seeing spiders on the ceiling or feeling that they are at sea. Common delusions people may experience include thinking that staff are trying to harm or even kill them.

Simple strategies to manage delirium

There are a number of strategies which can help to decrease the severity of delirium and reduce the duration. Below are a list of suggestions of actions that you can take.

Hydration

Check with the nurse if your relative is allowed to drink. If they are please encourage them to do so regularly.

Sleep/wakefulness

Please encourage your loved one to be awake during the day by talking to them about familiar things or playing their favourite music. Use simple language with short sentences. Allow lots of time for them to respond to you. Avoid asking too many questions.

Pain

If you think your loved one is in pain, please discuss this with the nurse.

Vision and hearing

Please ensure that your loved one has their glasses and hearing aids.

Familiar Items

Bring in one or two familiar items from home, such as photos and personal belongings.

How can I be more involved?

If you would like to be more actively involved in carrying out part of your loved one’s cognitive rehabilitation programme, a session can be arranged with an occupational therapist. The session can be arranged be either asking a member of staff to send a message via Epic chat to 'occupational therapy - critical care' or you can email the occupational therapy team directly.

Where can I get more information?

If you would like more information about delirium, please visit ICU Steps (opens in a new tab) or speak to one of our occupational therapists or critical care specialist nurses.