Any experiences of Delirium ?

[MrsCarmelaSoprano]

My mum has this at the moment and is in hospital, she is hallucinating and so, so frightened of... everything. It's absolutely heartbreaking. We're on week two of it now. Hard to see how it will resolve.

Yes my dad had it with a uti.

it did resolve. I don’t remember how long, sorry

Yep. It took 4 weeks give or take a couple of days. Got extremely nasty at points too. Once the infection was gone he was back to normal.

Do you know if there is an underlying cause? My dad had it twice: once after a general anaesthetic (and illness/recovery) and it eventually passed; and then again as he approached death (several years later). What are the HCP saying to you about it? Hand hold.

Yes, my dad had it during a hospital stay for an unexplained infection. It lasted a couple of weeks and was terrifying for him. Completely back to normal after the infection cleared. It’s happened a couple of times in the last few years (he’s just turned 80).

As PP have said, the cause makes a difference. If it's infection or just from the change of environment¹ it will probably sort itself out once those are sorted, although it can take weeks or even months to clear completely. If it's dementia related it may fluctuate but there's a significant chance it will never fully go away.

All you can do is reassure and try to 'ground' them with familiar items or talking about familiar things, and keep on top of the docs to find the cause and get them discharged as soon as feasible.

¹ Hospital stays can cause it even without any other factors - out of routine, terrible conditions for getting decent sleep.

uti’s can really make them crazy. Is she being treated for one?

She can absolutely come back from it, being in hospital is a major contributor to the condition as patients get dehydrated, prone to infections especially UTIs. It's a horrible and upsetting thing. I hope she can come home soon

DP had it recently in hospital, caused we think by lack of sleep, and hospital environment. It was terrible, he is actually terminally ill but the delerium seemed so much more difficult to deal with so you totally have my sympathies. It felt like it would never end at one point, but did clear gradually after being at home for a few (5?) days. We just kept saying ‘you’re safe, you’re at home’ or whatever very factual calming things. The OT in hospital was very helpful if you are somewhere with an OT.

My FIL had it secondary to heart failure. Came home after 3 weeks still a bit confused and lived another 5 years and was totally compos mentis for those years.

Thanks for your messages,they're making me more hopeful.

It was a combination of extreme pain from a bone break and shed loads of morphine,which she is now off plus being in an acute ward with no natural light for a week. She started to hallucinate the night she was given morphine then had a terrible day on Tuesday where she was completely out of it and absolutely terrified not letting anyone near her.

She is in a rehab at the moment ,she isn't well enough to be at home and I live 4 hours away so nothing is ideal. She lives on her own normally. I am going down to stay for 4 days so I can go in and see her every day which might help as she does remember me. She has no memory of the acute ward last week and asked me where home is 😢

It's so awful, I had no idea delirium was so scary.

My dad also had it after morphine. It lasted about a week and was awful. I had to stay at the hospital for a few nights with him as he getting really aggressive with the staff which was not like him in the slightest when he was well. It was awful, really upsetting to see and he was so scared. But then one morning he said a normal sentence out of the blue and was shortly back to normal.

Yes,mum was like that,it was dreadful. Her friend visited her today and said there was an improvement from last Thursday when she saw her. It'll be interesting to see if there's a difference between when I saw her on Friday and tomorrow. Her friend told her I was going down and she understood and was pleased .

Patients on my ward sometimes get post op delirium; due to either: the anaesthetic, the meds eg opiate pain relief, underlying infections (utis, chest, wound); dementia (which can suddenly worsen to acute confusion & disorientation for a few days post op but then the person often - not always - returns to baseline.), or DTs (delirium tremens caused by being off alcohol for several days - sometimes patients don’t tell the drs how heavily they drink at home so they don’t get medically detoxed post op - then get DTs.); constipation can actually cause delirium (constipation is really common post op); also serious mental illness eg schizophrenia can worsen post op causing maybe an episode of psychosis.

It’s usually patients over 60 who are most prone to delirium and they can behave in extremely out of character ways. But.. my sister had a short episode of post surgery delirium at age 19 due to morphine.

Often they do recall what happened while they were delirious and obviously they can feel very embarrassed or even guilty for being confused or violent.
But luckily not everyone remembers.

The key thing post delirium is to reassure the patient as much as needed that they are safe and not in trouble if they have been aggressive.

Sometimes delirium can last a few months - it’s worth bearing this in mind before thinking an older individual has dementia.

After morphine it's very common indeed.

If she is in rehab in the hospital I'd ask them about 'discharge to assess' (called intermediate care in some areas). This would be either back home with a care package or, better in her situation as she presumably has limited movement of the break and is needing physio, an NHS funded stay in a care home with visiting physio. Usually for a month or 6 weeks.

Even though it will be a less familiar environment than her own home, a care home it will be much better than a hospital ward for helping the delirium resolve - natural light, better sleep, more activities to occupy her mind.

Yes, with MIL after surgery and to a lesser extent, every time she had a UTI.

After the surgery it was for around 3 weeks before she went back to her severe dementia 'normal'.

The rehab is actually wonderful and she has her own room and the staff are fantastic,I think moving her would be terrible so hope that doesn't happen. She definitely isn't well enough to be at home on her own even with care package in place.

ETA It's called intermediate care where she is.

Yes, when my FIL came home he was still slightly delerious and paced the floor for days moaning things had been moved. We had moved things to reduce clutter but he wanted them back.

My dad was delerious after a seizure and was awful when he came home. My opinion on the intermediate discharge team not good..... But he got there in the end.

Yes, it's very common. IME they came out of it and remembered nothing inc whether we visited them so don't feel bad and try to look after yourself too

Very common side effect of UTI in the elderly, first time I saw my late mum going through it, was so heartbreaking and upsetting for her and me. She got over it once the infection was successfully treated.

It’s a very common issue but for some reason it doesn’t seem to be something that family members are warned about. My DM got much better when she was home, unfortunately the things she believed during her delirium weren’t so far out there that they couldn’t possibly be true and three years on she still believes these hallucinations actually happened. It’s impossible to get her to believe otherwise as she knows that some things were implausible like the woman in the bed opposite turning into a cat. The rest could have happened but didn’t!

I spent all afternoon with her, she's drinking more which is good as they were worried yesterday. She was up and dressed and sitting in a chair , she was pleased to see me and the nurse said she was responding really well to me so I'm glad I came down. We did some drawing together as she's very artistic, it soothed her as she was humming but drawing was just scribble but she kept saying " Ooo look at that" so it obviously meant something to her.

She got very upset and said people's faces keep changing and the slightest movent sets her off screaming.

She has a catheter at the moment so no UTI as they keep testing, so still looking like it was the morphine that triggered it. Can't ever see her getting back to how she was tbh, have to admit I had a big snotty cry this evening. 😢

Yes, my mum had it after surgery for cancer. It was very distressing for everyone involved.

After she was discharged from hospital we worked out from timings that it was either caused/made worse by one of the medications the hospital put her on. We cut out the medication and symptoms disappeared immediately.

Have there been any new medications introduced?

They've all been cut back now. She's on a pain patch as she has a broken back so she needs it but she's had that before and tolerated it ok. This was happening well before they introduced the pain patch though so really seems like it was the morphine - which she's not on now.

Actually looking back ,she had symptoms before she even went to hospital.

Are they doing urine cultures, or just dip tests? UTIs don't always show up in the the latter.