A Patient with Delirium. Don’t Say: “You’re Confused!”

Here are some key points:

1. The narcotic made Sue much more confused. For that reason, the hydrocodone was stopped. She is now on acetaminophen (Tylenol ®) around the clock. Fortunately, the pain is controlled.
2. Delirium is a dream like state and recall of events is generally very poor. Telling Sue what happened can make her feel ashamed, more confused, defensive, and anxious. Discuss the event only if the patient herself brings up the subject.
3. When patients are confused and anxious, the best thing to do is just listen patiently and attentively. An occasional clarification such as “what happened then?” is fine. But avoid correcting confused patients. Talk slowly. Comments such as “Oh my goodness” are fine.

   

4. This is not easy but can be learned. Relax. A soothing presence can calm a confused person. Sit down. Maintain eye contact. Sometimes sitting slightly lower and looking up at a patient is comforting. A light touch on the elbow is reassuring.
5. Help bring the person out of delirium. Go on a short walk and gradually return to normal routines. As Dr. Inouye pointed out, socialization can help. It’s best to have a confused person socialize with someone who is well liked by the patient. That person also needs to have a calm presence.
6. Take a deep breath. Get time for yourself. This means being open to and asking for help.
7. Take a big breath again. Delirium is likely to improve from day to day.

In our next post, Dr. Inouye will talk about her continuing work to prevent, identify and manage delirium.

Warmest Aloha,

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PS: I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.