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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 1 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:

upset, anxious or suspicious
disorientated (unsure of the correct time and where they are)
easily distracted with poor concentration or rambling speech
quiet and sleepy or restless and agitated
occasionally aggressive or angry
more awake at night and sleepier during the day.

Treating delirium in palliative care

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 their 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:

Have a calm familiar person with them and try to be kind and comforting.
Be supportive. What the person is experiencing seems real to them.
Reassure them that they are safe, and you are there and want to help.
Respond to their emotions (such as fear) and do not argue about the facts.
Drop gentle reminders into the conversation to help them understand where they are, what time it is and what is going on.
Reduce noise and keep visitors to a minimum as too much stimulation can add to confusion.
Make the room light during the day and dark at night.
Sometimes having a clock, calendar and personal objects nearby can help.
Check that their glasses are clean, and their hearing aids are working and being used.
If your loved one becomes agitated, try not to restrict their movements. They need to be safe, but it is also important for a person with delirium to continue to move and walk if possible.

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 it is 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 is hard, try not to take what they say or do personally. They are not thinking clearly and are not 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 t2 wo patients instead of 1!

Written by Te Whatu Ora Waitaha Canterbury end of life care and bereavement group and Nurse Maude Hospice. Adapted by HealthInfo clinical advisers. Last reviewed October 2024.

Sources

The information in this section comes from the following sources, some of which may be clinically complex or not available to the general public

Canterbury Community HealthPathways – Cough in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Dyspnoea in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Pruritus (itch) in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Weakness and fatigue in palliative care, retrieved December 2016.

Canterbury DHB – Palliative care guidelines (http://cdhb.palliativecare.org.nz/4207.htm), retrieved August 2016.

Nurse Maude – Symptom management, retrieved December 2016.

Palliative Care Australia – Facts about morphine and other opioid medicines in palliative care, retrieved February 2017.

Palliative Care Australia – Learn more about pain and pain management, retrieved February 2017.

South Island Alliance – Health of older people useful resources (https://www.sialliance.health.nz/programmes/health-of-older-people/useful-resources/), retrieved September 2022.

UpToDate – Managing pain when you have cancer, retrieved February 2017.

Image and embedded video sources

Image of a car driving towards snow-capped mountains from mychillybin (image ID 100128_358). November 2016.

Image of a carer helping an elderly woman from Shutterstock (image ID 71309584). November 2016.

Image of a child ill in bed playing cards from Shutterstock (image ID 222626227). November 1016.

Image of a confused elderly man in bed being comforted from Shutterstock (image ID 1897170943). November 2022.

Image of a couple driving a car from Shutterstock (image ID 174939050). November 2016.

Image of a cup of lemon and ginger drink from Shutterstock (image ID 262006217). November 2016.

Image of a glass or water and pills from Shutterstock (image ID 176139605). March 2017.

Image of a nauseous woman from Shutterstock (image ID 174166217). November 2017.

Image of a person counting out pills into their hand from Shutterstock (image ID 251002813). November 2016.

Image of a person peeling oranges from Shutterstock (image ID 404915464). February 2017.

Image of a sick person lying in bed with their mouth open from Shutterstock (image ID 553734718). February 2017.

Image of a woman eating an apple from Shutterstock (image ID 173814083). February 2017.

Image of a woman looking at a pill and holding a glass of water from Shutterstock (image ID 145621765). November 2016.

Image of a woman lying back holding a cushion from Shutterstock (image ID 313042859). February 2017.

Image of a woman using a nasal spray from Shutterstock (image ID 342285080). October 2016.

Image of a woman who doesn't feel like eating from Shutterstock (image ID 151886909). February 2017.

Image of an elderly breathless woman leaning on a tree from Shutterstock (image ID 181672562). February 2017.

Image of an elderly man blowing bubbles with a child from Shutterstock (image ID 305524514). November 2016.

Image of an ill woman lying in bed from Shutterstock (image ID 319248689), February 2017.

Image of someone pouring medicine from Shutterstock (image ID 550073806). February 2017.

Image of someone putting cream on their hands from Shutterstock (image ID 193623662). February 2017.

See also:

Delirium

Looking after yourself when caring for someone who is dying

Page reference: 1074854

Review key: HIPAL-17434