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HealthInfo Waitaha Canterbury

Delirium in palliative care

Mate kuawa i te manaakitanga whakamaene

When a person is unwell with a serious illness, they may experience a disturbance in brain function called delirium.

Over a brief time (hours to days) the person can become confused and may struggle to think clearly or focus on tasks or conversations. This confusion can come and go and often gets worse in the evening. It may last a few days or up to several weeks. If the person is dying, the confusion may not improve as they get more unwell.

Older, frail people and people with dementia are more likely to develop delirium.

Causes of delirium

Often there is more than one cause and often no cause can be found.

Medicines can contribute to delirium. This might be from starting a new medicine, increasing the dose of a medicine or stopping a medicine.

An infection is another possible cause.

Symptoms of delirium in palliative care

Delirium makes paying attention and focusing difficult. People with delirium may be upset and restless, quiet and sleepy, or a mixture of both. They may see and hear imaginary things. They may fluctuate between being confused and seeming okay over the day. The person may become:

Treating delirium in palliative care

If necessary, let your healthcare team know if you think your loved one has delirium. Depending on the stage of illness and the goals of care, their healthcare team may organise some tests (such as blood or urine tests) to check what is causing the delirium.

The healthcare team may adjust the person's medicines.

As the person's body starts to weaken, it may not be possible to reverse the delirium in the last few days or weeks of life.

There are no specific medicines that treat delirium. But if someone is very agitated, frightened or wakeful at night they might be given a calming medicine.

Helping someone with delirium in palliative care

There are several things that you can do to help someone with delirium:

Looking after yourself when your loved one has delirium

It can be upsetting to see a change in how your loved one thinks and acts. Whānau (family) members often say that it's like they have lost their loved one during the delirium. They use phrases like “it's like he’s not with us" or "his mind is not with us”.

Try and see this as a just a phase of their illness. Delirium can cause a person to act out of character. They may lose their self-control or act in ways that are unexpected. They may be quiet and distant. Hallucinations can seem very real to them. Even though it's hard, try not to take what they say or do personally. They aren't thinking clearly and aren't themselves.

Be open with other family members about what is happening. Share information about delirium to help them understand and support you. It may help to share your feelings with someone. Try to look after yourself and get some rest. Remember to eat and drink to keep your energy levels up. If you can, go out for short walks. Nobody wants two patients instead of one!

Written by Te Whatu Ora Waitaha Canterbury end of life care and bereavement group and Nurse Maude Hospice. Adapted by HealthInfo clinical advisers. Page created November 2022.


See also:


Looking after yourself when caring for someone who is dying

Page reference: 1074854

Review key: HIPAL-17434