Delirium is very common in people with advanced illness. With delirium, people have times when they're suddenly confused and unaware of what's going on around them. They may become agitated and restless or withdrawn. Delirium can be very upsetting for family members to watch. If your loved one develops signs of delirium, let their doctor know right away. In some cases, the cause of the delirium can be treated. In others, steps can be taken to help manage delirium and ensure your loved one's safety and comfort.

Sometimes, delirium can be reversed by treating the cause. Delirium often has multiple causes. These can include:

• Medicines
• Infections or other medical illnesses (these can be mild or life-threatening)
• Changes in environment, such as being hospitalized
• Drug and alcohol abuse or withdrawal
• Electrolyte imbalance
• Pain
• Other problems, like anemia or nutrition deficiency
• Lack of enough oxygen
• Failure of organs, such as the liver or kidneys
• Unrecognized seizures

There are three forms of delirium: Hypoactive, hyperactive, and mixed. People can have one of these forms:

• Hypoactive. In a hypoactive state, people are sleepy and withdrawn. They may show little interest in their surroundings.
• Hyperactive. In a hyperactive state, people are excitable and agitated. They may become violent. And they may believe in or see things that aren't there.
• Mixed. In a mixed state, people change between being hypoactive and hyperactive.

Most people with delirium will also have the following symptoms:

• Changes in sleep patterns
• Confusion about time and place (disorientation)
• Wandering attention
• Disorganized thinking
• Problems with memory and speech
• Changes in mood or personality
• Hallucinations

Your loved one's doctor and health care team will try to find the cause of the delirium and treat it, if possible. Sometimes the cause can't be found. Or treatment may be available but not desired at this point in their illness. In such cases, the main goal of treatment is to manage the delirium and keep your loved one safe and comfortable. You may be told to do the following:

• Provide safe and familiar surroundings. Keep your loved one's room clean and well-lit. Have familiar objects nearby, like a favorite blanket and family photos. Add a clock next to the bed and a calendar on the wall to help your loved one keep track of time.
• Limit contact with strangers. Try to make sure that your loved one receives care from the same doctors or caregivers. Keep visitors restricted to family members or close friends to reduce confusion.
• Have a regular day and night schedule. During the day, open blinds and windows or keep the lights on to encourage your loved one to stay awake and alert. During the night, dim the lights and keep noise levels low to encourage sleep.
• Expect sudden changes in behavior. There may be times when your loved one is normal and alert. But other times they aren't fully present. Your loved one may forget who you are. They may also imagine things or speak to people who aren't there. Try to stay calm during these episodes. It may help to provide a gentle touch or reassuring words. Or you may choose not to speak and simply listen.
• Use positive language. Try not to raise your voice or argue with your loved one. Keep conversations simple. If your loved one is confused, state simply and calmly where they are and what's going on.
• Minimize the use of restraints and encourage movement as soon as possible. These can make a person more anxious, afraid, or angry and increase confusion. If needed, arrange for a 24-hour caregiver or nurse, so your loved one is never left alone. Or take turns sitting next to the person's bedside with other family members and friends.
• Alert the doctor if your loved one's delirium gets worse. If needed, medicine can be prescribed to help your loved one sleep or stay calm.

Treatment of delirium may change when your loved one is near death. The doctor and health care team can help prepare you for what to expect in the last days of life. If delirium is severe, ask the doctor about choices for keeping your loved one comfortable. Don't be afraid to ask questions or get help at this time. If more support is needed, other health care team members, like a social worker or spiritual advisor, can help.

Tips to help prevent delirium include:

• Use visual and hearing aids as needed
• Manage pain
• Keep watch for the use of certain medicines or avoid them altogether. Certain medicines can trigger delirium.
• Prevent medical complications or treat them if they happen. Some medical conditions are known to cause or make delirium worse.

Caregivers of people with delirium play an important role that has three parts:

• They try to prevent delirium and spot it if it happens.
• They act as advocates for their loved ones.
• They help to keep watch for symptoms.

But caring for people with delirium can take its toll on caregivers. They need support to cope with the stress and emotions of providing such care. If you're a caregiver to a person with delirium, you may find a support group or educational materials helpful during this stressful and emotional time.