Why delirium should be treated as a medical emergency

While most people recognize chest pain is an emergency that requires a quick response to save a life, few understand that a sudden onset of confusion may signal a “brain attack” caused by a myriad of serious medical conditions.

“The reason delirium is a medical emergency is because if you let the ‘insult’ to the brain go on too long, there’s a risk of permanent brain injury,” explains Mary Kjorven, a regional clinical nurse specialist in gerontology at IH. “The sooner we react to the symptoms of delirium, the better the outcomes for the patient. If we let the cause of the delirium go on too long, we can end up with an impaired brain, and even dementia.” 

There are many other causes of delirium including:

• Unresolved pain
• Poor nutrition and/or dehydration
• Retention of urine and/or fecal impaction
• New illness
• Immobility
• Sleep deprivation
• Change in environment
• Medications
• Metabolic imbalances

Even health-care professionals can mistake delirium for dementia, especially in the older adult population. We should always respond immediately to any sudden change.

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The key symptoms of delirium include:

• Acute confusion – A person is different today from yesterday
• Fluctuating course of symptoms – The confusion comes and goes
• Difficulty maintaining attention
• Incoherent – Speech is rambling or ideas aren’t flowing logically
• Hyperactive or hypoactive, that is, lethargic, drowsy or difficult to rouse

Attention is in fact one of the main ways we differentiate dementia from delirium. Persons with dementia can often maintain attention (for example, eye contact) until quite late into their disease process. A person with delirium will often jump from one thing to another and their behaviour may fluctuate between hyperactivity and lethargy/drowsiness. They may even fall asleep in the middle of a conversation.

What muddies the waters even more is that persons with dementia are at greater risk for developing delirium (on top of their dementia). The key is knowing what behaviours are usual for a person and being able to identify a sudden change in behaviour. Dementia is a slow downward decline in brain function and isn’t sudden.

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Though delirium should be treated as an emergency, going to the emergency department or calling an ambulance may not be the answer. Sometimes an unfamiliar environment can make delirium worse, especially in persons with dementia. 

If you see a sudden change in behaviour in a loved one, following up as soon as possible with a physician or nurse practitioner is important. If that’s not possible, call 811 or go to an urgent primary care centre.

When describing symptoms, Mary recommends you use the word “delirium.” For example, “I think my dad may have delirium because his behaviour has abruptly changed. He usually gets this way when he has urine retention and an infection. Last week, he was playing bridge and golfing three times a week. Now he is slurring his words and seeing spiders on his bed.” This is not dementia.

The most powerful advocate for prevention, recognition and response to delirium is an informed person, whether that person is a health-care professional, a caregiver or a loved one.

You can learn more about delirium through the International Federation of Delirium Societies.

March 13, 2024 is World Delirium Awareness Day. This day brings attention to the importance of early recognition and intervention of delirium, and to raise awareness of the latest research, guidelines, and best practices in the field.

Mary Kjorven, R,N BsN, MsN, PhD GNC(C), is a regional clinical nurse specialist (CNS-C) in gerontology, and a nurse continence advisor. She’s on the Seniors Specialized Care Transformation team at Interior Health, and teaches for the UBC Faculty of Medicine, Thompson Rivers University School of Nursing, and UBC Okanagan Faculty of Health and Social Development.

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