Delirium

Delirium is a common medical problem that is characterised by changes in mental function. Delirium occurs more frequently in older patients and patients with advanced illnesses, including those with advanced cancer or at the end-of-life. 

Patients with delirium will think and act very differently from normal people. The condition can be difficult and stressful to the patients as well as their loved ones. It may also make it hard for the health care team to take care for other symptoms. A peace of mind is essential for the patients and their loved ones under this circumstance. 

Possible causes of delirium include:

• Medications:
  • Pain medications
  • Steroids
  • Sleeping pills
  • Anti-emetics
  • Chemotherapy
• Electrolyte imbalance:
  • Such as high calcium level in blood, dehydration, low blood sugar level
• Infection:
  • Urinary tract infection, pneumonia, brain infection and blood infection (sepsis) can cause delirium.
• Organ problems
  • Certain organs not working properly, including liver, kidneys, heart, or lungs
  • Cancer primary from the brain or metastasis to the brain can cause delirium.

Symptoms usually occur suddenly and causes both physical and mental changes. Someone with delirium may:  

• appear confused and forgetful  
• Not be able to get oriented to time of day or their own location  
• Not able to pay attention  
• act differently from their usual self  
• have changes in their function, i.e. mobility and the ability to care for oneself
• be very agitated, sleepy, quiet and withdrawn, sleepy or a combination of these  
• have changes to sleeping habits, such as staying awake at night and being drowsy during the day
• feel fearful, upset, irritable, angry or sad
• see illusions
• lose control of their bladder or bowels (incontinence)

Treatment depends on the cause of the delirium, including:

• antibiotics for infection
• intravenous fluid for dehydration or electrolyte disturbance
• changing medicines or stopping the use of medicines that cause delirium

The healthcare team will create a calm environment for patients with delirium by:

• ensuring good lighting during the day and darkness of the room night
• reducing noise in the room 
• providing a clock or calendar in the room
• limiting the number of visitors

Patients may have delirium at their end of life. If the patient with delirium is very agitated, or the condition does not improve with other treatments, the doctor may recommend using sedation. Sedation is a type of medication that puts a person into deep sleep. The goal of sedation is to make the person feel comfortable.

What can I do if my loved one has delirium?

• Bring familiar objects from home, such as photographs or the patient’s favourite blanket.
• Play the patient’s favourite music softly.
• Speak with a quiet and reassuring voice. Give gentle reminders on what day and time it is, where the patient is, who the patient is and who you are.
• Reduce restlessness and help keep the patient active by going on short walks.
• Try to have someone with the patient as much as possible. Family members can take shifts to make sure someone is there around the clock.

American Society of Clinical Oncology (ASCO): Mental Confusion or Delirium