These features are as follows: (1) an acute onset of mental status changes or a fluctuating course, (2) inattention, (3) disorganized thinking and (4) an altered level of consciousness. The patient is diagnosed as delirious (i.e. CAM positive) if he or she has both features 1 and 2 and either feature 3 or 4.

Behavioral disturbances such as psychotic symptoms, mood disturbance, agitation, apathy, aggression, combativeness, and “wandering off” should be identified and documented as a behavioral disturbance. Delirium superimposed on dementia and “sundowning” should also be documented whenever they occur.

Over time, the term delirium has evolved to describe a transient, reversible syndrome that is acute and fluctuating, and which occurs in the setting of a medical condition. Clinical experience and recent research have shown that delirium can become chronic or result in permanent sequelae.

Poor Thinking Skills (Cognitive Impairment) Poor memory, particularly of recent events. Disorientation (for example, not knowing who or where you are). Difficulty speaking or recalling words. Rambling or nonsense speech.

Patients with delirium can present with agitation, somnolence, withdrawal, and psychosis. This variation in presentation can lead to diagnostic confusion and, in some cases, incorrect attribution of symptoms to a primary psychiatric disorder.

What I learned today: How to care for someone with delirium

1. Surround them with familiar objects and people.
2. A clock provides visual stimulus and helps them keep track.
3. Speak in short, clear, simple sentences.
4. Explain, explain, explain.
5. Check that they’ve heard and understood.
6. Answer each time as if it’s the first.
7. Don’t talk over their head or pretend they’re not there.

A healthcare provider may prescribe antipsychotic drugs, which treat agitation and hallucinations and improve sensory issues. Antipsychotic drugs include: Haloperidol (Haldol®). Risperidone (Risperdal®).

How to Help a Person with Delirium

1. Encouraging them to rest and sleep.
2. Keeping their room quiet and calm.
3. Making sure they’re comfortable.
4. Encouraging them to get up and sit in a chair during the day.
5. Encouraging them to work with a physical or occupational therapist.
6. Helping them eat and drink.

In the long term, delirium can cause permanent damage to cognitive ability and is associated with an increase in long-term care admissions. It also leads to complications, such as pneumonia or blood clots that weaken patients and increase the chances that they will die within a year.

Delirium often clears in a few days or weeks. Some may not respond to treatment for many weeks. You may also see problems with memory and thought process that do not go away. Talk to your health provider about your concerns.

Complications of delirium may include the following:

• Malnutrition, fluid and electrolyte abnormalities.
• Aspiration pneumonia.
• Pressure ulcers.
• Weakness, decreased mobility, and decreased function.
• Falls and combative behavior leading to injuries and fractures.
• Wandering and getting lost.

Usually, delirium gets better. In 6 out of 10 (60%) people, the symptoms disappear within six days. Others may continue to experience some symptoms for longer. About 1 in 20 (5%) people may still suffer from delirium more than a month after they first had symptoms.

Overall, the most common causes of delirium are the following: Drugs, particularly drugs with anticholinergic effects, psychoactive drugs, and opioids. Dehydration. Infections, such as pneumonia, a bloodstream infection (sepsis), infections that affect the whole body or cause a fever, and urinary tract infections.

A new study of 24 observational studies from researchers at Columbia University Vagelos College of Physicians and Surgeons found that delirium may cause significant long-term cognitive decline. The findings were published in JAMA Neurology. Delirium is the most common surgical complication in adults older than 65.

Abstract. Terminal delirium is a common symptom at the end of life that may increase family and caregiver stress and impact the bereavement process for loved ones who do not understand the dying trajectory.

A Guide To Understanding End-Of-Life Signs & Symptoms

• Coolness. Hands, arms, feet, and legs may be increasingly cool to the touch.
• Confusion.
• Sleeping.
• Incontinence.
• Restlessness.
• Congestion.
• Urine decrease.
• Fluid and food decrease.

Patients may be very weak, but insist on changing positions often. They may yell out and show anger toward people around them. Some people with delirium are afraid, and may want to go to the emergency room or call the police because they believe someone unseen is trying to hurt them.

Breathing may become irregular with periods of no breathing or apnea lasting 20-30 seconds. Your loved one may seem to be working hard to breathe — even making a moaning sound. The moaning sound is just the sound of air passing over very relaxed vocal cords. This indicates that the dying process is coming to an end.

The Lazarus sign or Lazarus reflex is a reflex movement in brain-dead or brainstem failure patients, which causes them to briefly raise their arms and drop them crossed on their chests (in a position similar to some Egyptian mummies).