Recognizing Delirium: A Checklist for Caregivers
Delirium is a sudden change in a person’s mental state that fluctuates over short periods of time. It can cause a person to have a hard time paying attention or following a conversation. Thinking and speech may be confused, illogical, unclear, and random. A person’s mental state may vary from being restless and alert to sluggish and sleepy.
Delirium can sometimes be mistaken for dementia. Often the two conditions occur together. But delirium happens over a short time – hours to days. Dementia happens more gradually, over months or years.
Delirium is a medical emergency. If delirium is not diagnosed and treated, it can lead to permanent problems or even death.
A Checklist of Delirium Signs
Below is a checklist of the signs of delirium. It’s important to remember that the signs of delirium happen quickly, over the course of hours or days. They can come and go, and may be worse later in the day. And a person may shift between the signs.
Does the person:
Seem acutely more sleepy and quiet than usual OR more restless and disturbed?
Seem suddenly confused or disoriented?
Act in a violent way?
Have trouble paying attention and focusing on a conversation?
See things that others can’t see?
Hear things that others can’t hear?
Believe things that aren’t known to be true?
Think that people want to harm them?
Change the subject too often while talking?
Talk about things that others find strange?
Have anxiety, be sad or tearful, or have intense feelings of joy and excitement (euphoria) that changes rapidly?
Seem unsteady while walking and not a result of a prior medical condition?
Have a hard time focusing on simple tasks?
If you’ve answered “yes” to any of the signs above, your loved one may have delirium. If you think the person has any of the signs above, you can do two simple tests to check their mental state. One tests their attention. The other tests how clearly they are thinking.
Say to the person, “I am going to read you a series of 10 letters. Each time you hear the letter A, squeeze my hand.” Read these letters 3 seconds apart: S A V E A H A A R T. Count each time the person does not squeeze your hand when you say the letter A. Count each time he or she squeezes your hand on a letter other than A. If he or she has 3 or more errors, the person may have delirium.
Ask the person these four questions:
Will a stone float on water? (Correct answer: No)
Are there fish in the sea? (Correct answer: Yes)
Does one pound weigh more than two? (Correct answer: No)
Can you use a hammer to pound a nail? (Correct answer: Yes)
Count each time he or she gives a wrong answer. If he or she has 2 or more errors, and they could previously answer these questions, the person may have delirium.
When to Get Medical Help
If someone is showing signs of delirium, call his or her health care provider right away. Or call 911 or your local emergency number. Tell the health care provider or emergency services person about the signs of delirium you have seen.