Many people experience confusion during an acute illness and hospital admission. When confusion is severe, it is often called delirium. Delirium is temporary and usually improves shortly after the cause is treated, but for some people it takes several weeks to resolve and might continue when you have been discharged from hospital.
Causes of acute confusion and delirium
Delirium is common after being in intensive care or on breathing machines whilst in hospital. However, there are many different factors that can cause delirium or make it worse:
- Infection
- High temperature
- Pain
- Recent surgery
- Constipation
- Dehydration
- Being in a new or different environment
- Lack of sleep and loss of daily routines
- Low oxygen levels
- Side effects of medications
It is important to note that delirium and dementia are separate conditions, although people with dementia are at higher risk of developing delirium.
Symptoms of delirium
Delirium can change quickly during the day, so there might be times when you feel more or less confused and disorientated. It can be helpful to keep a diary, noting which times of the day are worse and whether these are linked to specific reasons (if possible ask a family member to help as well).
Common symptoms:
- Feeling restless, anxious or agitated
- Difficulty remembering things
- Feeling disorientated and unable to remember where you are
- Troublesome thoughts or images
- Difficulty concentrating
- Difficulty sleeping – or feeling very drowsy and sleeping a lot
Delirium can be frightening and isolating, especially if you are troubled by difficult thoughts, memories or images. You might find it helpful to talk about these with your family, GP or other health care professional and you should certainly seek medical advice if your difficulties continue after 3 months.
This page covers some strategies and general advice to aid your initial recovery period at home. Everyone’s recovery is different and you might find other resources or strategies that also help.
Activities, routines and staying orientated
- Maintain a daily routine: get up and go to bed at the same time each day.
- Keep a diary or calendar with you so you know what day and date it is. Also use these to note things you need to remember each day, such as appointments and important tasks.
- Wear a watch or keep a clock in the room so you can check the time of day.
- Keep a list of activities that you enjoy doing and choose something on the list every day.
- Try doing some puzzles to keep your mind active e.g. crosswords / word-searches / sudokus.
- Try to get some natural light and fresh air during the day. If you are unable to go out, sit by a window.
- Try to spend time with other people or talk on the telephone.
Eating and drinking
For detailed information and helpful advice on eating, please see the pages on ‘Nutrition to Help Recover from Covid-19’. Importantly:
- Try to eat 3 meals a day.
- Choose foods that you enjoy eating.
- Maintain your fluid intake: drink water or other fluids regularly throughout the day (unless advised against this by your doctor).
Eyesight and hearing
- If you wear glasses and hearing aids, keep them with you so you remember to put them on.
- Check whether your hearing aid batteries need replacing: contact audiology at Ashford hospital (Tel: 01784 884351). Replacement batteries and tubing can be posted to you.
- Sight for Surrey are currently offering telephone advice and guidance for people with hearing and visual impairments (Tel: 01372 377701 / Text: 07860 026269).
Sleeping
- Keep to a regular routine: get up and go to bed at the same time each day.
- Have a warm drink before bedtime, such as warm milk or herbal tea.
- Avoid caffeine (tea & coffee etc.) after 4pm.
- If you have difficulty sleeping, try wearing an eye mask and ear plugs.
- Try some relaxation exercises or listen to music before bedtime.
Exercise
For detailed information on exercise, please see the pages ‘Developing Exercise Tolerance’. Importantly:
- Try to do some exercise every day – if unable to go out, you can walk around your home (use a walking aid if needed).
- Consider doing some chair / bed exercises (ask a physiotherapist for advice if needed).
<
Relaxation
Set aside a specific time for relaxation each day. There are many online resources with guided relaxation techniques and exercises (see below). Here are some ideas:
Try this exercise if you feel anxious or have difficulty sleeping:
- Get into a comfortable position and make sure you are warm enough.
- Imagine you are in a relaxing place such as a beach, a field with wild flowers, or your favourite place.
- Breathe in slowly through your nose then breathe out slowly through your nose. Try to make the breaths longer and slower. Repeat this 5 times.
Another technique is progressive muscle relaxation: the idea is to tense and relax the muscles in your body in turn.
- Get into a comfortable lying or seated position and make sure you are warm enough.
- Start by tensing (clenching) the muscles in your toes and feet as you breathe in, then relaxing them fully as you breathe out.
- Tense the muscles in your legs as you breathe in, then relax fully as you breathe out.
- Move up your body from your legs to your stomach area, then to your arms, hands, shoulders and face – tensing and relaxing the muscles in turn.
- Take a few moments to be aware of how you feel.
Online resources / further information
- Ashford St Peter's: Delirium
- RCP: Delirium
- Sight for Surrey
- NHS: Ways to Relieve Stress
- MIND: Relaxation Exercises
- Headspace: How to Relax
