Tip Sheet: Managing Delirium in Older Adults

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Delirium is a sudden change in mental status that can be caused by a number of factors. Delirium often occurs when older adults are in the hospital or after they have surgery. Many factors can contribute to delirium, including acute illness, surgery, and medications. In addition, for some people, disruption of their regular routine may contribute to sudden confusion or changes in behavior.

When delirium isn’t recognized, it can delay an older person’s recovery. And prolonged delirium can have a lasting impact on an older person’s health and well-being.

Family members and friends can play a key role in recognizing and preventing delirium. Here’s how.

What to Look for: Signs of Delirium

Delirium can start to happen in just a few hours. It can come and go, and symptoms can change quickly. As a friend or family member, you know the older person better than the hospital staff, so you are often the first person to see signs of delirium. Be sure to report your concerns right away.

Common signs

  • Confusion
  • Frequent mood swings
  • Memory loss, including forgetting recent events or family members’ names
  • Sudden changes in personality or emotional state
  • Decreased attention or concentration
  • Periods of alertness that come and go throughout the day
  • Hallucinations (seeing or hearing things that are not there)
  • Insomnia and changes in usual sleep patterns
  • Slower movements or unusually restless movements
  • Changes in speech, such as saying things that don’t make sense

What You Can Do: Caregiving Tips for Older Adults with Delirium 

Since you know the older person best, you can quickly pick up on changes in their mental state. Tell the healthcare staff right away if you notice anything unusual.

Stay with the older person as much as possible
Friends and family offer comfort and familiarity. Many hospitals allow family members or friends to stay overnight in the hospital room. Try to provide calm reassurance and comfort. Being there for mealtimes is also important and supports better food and liquid intake.

Keep eyeglasses, hearing aids, and dentures with the older person
They are often put away at the hospital, and this can leave an older person disoriented and less able to function.

Help the older person remember where they are
You can gently and calmly explain why he or she is in the emergency room, hospital, or other facility. Offer frequent, simple explanations of what is happening and of any changes in routine.

Make the person’s surroundings feel more familiar
Bring a few family photos and familiar objects to the hospital, such as a favorite blanket.

Encourage physical activity, games, and conversation
Ask the hospital staff if you can help the older person sit in a chair or go for a walk. Simple games, quiet conversation, or other pastimes the person enjoys are also helpful.

Bring a current medication list to the hospital
It’s important for all healthcare providers to know all the medications an older person is taking, along with the dosages. Be sure to include over-the-counter medications and supplements, such as vitamins and herbal remedies. It’s best for an older person to have a medication list with them at all times.

Bring a list of the older person’s health issues
Having this information written down and on hand is always helpful for an older person, particularly if they are taken to the emergency room. Don’t forget to include any allergies. And also be sure to include contact information for other healthcare professionals involved in the older adult's care.

Reversible Causes of Delirium

In addition to the above steps, delirium can often be reversed by treating some of the common causes. You can discuss these with the older person’s healthcare providers. Common causes include:

  • Starting new medications or changing current medication doses
  • Stopping medications that the person has been on for a long time
  • Stopping regular use of alcohol or sleeping pills
  • Pain that is not treated well
  • Constipation
  • Thyroid problems
  • Infections, especially of the lungs or urinary tract
  • Not getting enough liquids (dehydration)
  • Stroke
  • Heart problems, including heart failure and irregular heart rhythms


Last updated July 2019

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