Delirium in hospital

[Chenecinquantecinq]

Just wondering if anyone has any experience? Elderly 86 yr old relative in hospital for a broken hip. Had delirium post op seemed to resolve but returned on ward transfer. They suggested possible dehydration but 5 days on a drip no improvement. Relative won’t eat as “food poisoned” and “they’re” out to get him. Just garbles non sensical stuff. Seeming ok prior to fall but having looked through papers at his home since fall finances in a total mess and clearly wasn’t coping, possible dementia? No LPA think hospital/social services might attempt a deprivation of liberty and move to LA care home? Is this likely? Thanks

Hospital induced delirium is a problem-unfamiliar environment etc.

also have they checked for UTI - that causes delirium in elderly patients quite often

I would suggest these before they do anything drastic. Unfortunately you do need to push these checks. Hospitals can be chaotic even in good times but they seem particularly bad at the mo so things that should be obvious get missed.

wishing him a speedy recovery and hope you're doing okay

A fall or a hospital stay can trigger sudden deterioration of the mental state of someone who has early stage dementia. If they have ruled out other common causes of delirium (infections, particularly UTIs, or sodium or other electrolyte imbalances) then that may well be it.

If he is physically fit for discharge but still delirious, then yes, some kind of possibly short-term placement in an assessment unit or care home is possible. Are you next of kin, even if you don't have LPA for him?

Hi I work on a complex geriatric ward as a HCA - happy to answer specific questions as best I can.

Dols is quite likely if they are worried that the patient might try and 'escape' or they are refusing treatment/procedures - it's a tool rather than a permanent decision and does not mean they lack capacity. It means we can do stuff in best interest of patient rather than getting informed consent to do things like bladder scan, ecg. It also allows us to use such things as alarms that sound if they try to get out of bed or to put mitts on them if they are pulling out cannulas as these are viewed as restrictive.

Delirium is variable in permanence- it's possible to come back from it, although this can take weeks/months.

Unfortunately a medical episode in the previously well (or just about managing) elderly can have devastating results. It is not always possible to get back to their prior base line of ability - both physical and cognitive.

The ward will undertake a care needs assessment - so keeping records of and reviewing how much intervention they need from care and nursing staff on a 24hr basis. Physio and occupational therapist will assess potential for rehab.

In terms of discharge then the options are home with package of care, discharge to an assessment/rehab bed on a temporary basis, residential care or nursing care.

This will all take time, weeks, more likely months. There will be medical staff and social workers involved in all the decisions and even without LPA they should be involving the next of kin in discussions/decisions. If there are a few family members we would usually have one as a main point of contact, as to update and involve everyone individually would be far to time consuming.

How long post op and post ward move is it?

It can happen after major surgery but should settle back to whatever their normal is.

Many elderly patients get delirium during a hospital stay - common causes
UTIs
Dehydration
After effects of General anaesthetics
Side effects of painkillers (my mother had a really bad reaction to Oxycodone after knee replacement surgery.
Cogitative decline exacerbated by being in an unfamiliar place

delirium is super common in hospitalized injured seniors and can take months to resolve.
they often times do not return to the same level of independence following delirium.
this along with the statistics that 22-25% of adults with a broken hip will die within the year means that yes ss and care teams will often move patients to a long term respite bed due to the slow convalescence and unlikely return to independent living.

Thank you everyone. Yes he’s negative for obvious things like UTI and constipation. He was dehydrated but has now had IV fluids for 5 days (not medically trained but seems a long time to me to not see any improvement). Operation was weak before Christmas. His home (lives alone) was unsafe. I’ve just spent a lot getting it upgraded but seems it’s now unlikely he’ll go home. I spoke to Ward Dr she hinted he’s not going home even if medically ok. Not sure whether to apply to Court of Protection under emergency powers (they might not see this as an emergency I don’t know). I am a Deputy already for another relative but that took over a year to go through Courts. My thoughts are he’d be best selling home and using money to pay for a private care home. I’m not sure if COP3 are done for delirium or if it’s sometimes too transient. I don’t even know if we should stop helping him pay his bills etc.

My dad had this when he was in hospital after a minor heart attack in 2020. It was made worse by the Covid restrictions at the time which meant none of us could visit him to provide him with familiar faces. It must have been quite scary for him.

He has been diagnosed with mixed dementia since but had some symptoms beforehand. It took some time to convince him that things that he thought were very much real were in fact delusions. Also he tried to escape the ward a few times. And my sister in particular had some strange phone conversations with him when he was in hospital.

But now, in 2025, he's doing pretty well and I almost forget he had this. Partly because we're dealing with him in the here and now iyswim.

I should add that we (his wife and daughters) hadn't really heard of this, and reading up at the time, we were worried he wouldn't really recover from the experience.

He’ll be 90 in April.

@Chenecinquantecinq in my experience it's was frowned upon for family to sell the house prior to 6 months or more time. should he improve being totally homeless is more drastic a situation (even with money in the bank) than having the house sitting vacant for a long period due to the absolute shortage of long term care beds period.

Is he on the delirium pathway?
Has he been seen by a dietician?
Has he been seen by an Occupational Therapist?
I presume you don't have LPOA?
Sounds like he's not medically fit for discharge currently anyway, so all you can do is ensure he is on the pathway, is seen by OT and dieticians and help as much as you are able with his delirium - ensure he has day and night clothes, bring in familiar objects, give him some kind of clock / watch and calendar, bring in permitted food and drink that you know he normally enjoys, ensure he sits out in a suitable chair a couple of times during the day etc. post op delirium can last for months.

It's definitely early days if the surgery was just before Christmas. It sounds like the Dr is managing your expectations of what happens next, discharge planning will start when he is 'medically optimised for discharge'

How is he managing with mobility/continence?

As pp suggested you can do things to help with his orientation by bringing in familiar things for him, make sure he has glasses/hearing aids etc, food that he likes.

My MIL had dementia and fell and broke her hip. The shock made her dementia fall off a cliff - suddenly much much worse. I think that's quite common. I'm really sorry.

At 92 my FIL had a hip replacement and then a small heart attack and developed delirium. He was awful. Ranting and screaming and undressing

Aged 97 now and living at home fully compos mentis and ordering stuff from Amazon to do gardening experiments (he was in agriculture) so some fo come back.

Can second the suggestion of getting the OTs in to se if they can help if this hasn't been done already.

When DMIL was in with Delirium they were able to help her to feel more settled. Until that point she'd thought that she was on a train station and was constantly running up and down the ward to catch her train.

Can you speak to the Discharge Clerk today to see what their plans are?

After having several Oldies in Hospital we've learnt the hard way just how pivotal the Discharge Clerk is. If you can get there, take them in something like individually wrapped chocolates to share or a pack of naice pens and ask them what the plans are.

You might have to ask for insist on a Multidisciplinary meeting before discharge to make sure he gets everything that he needs post discharge.

It's not an easy situation to be in is it?