Delirium when someone has a terminal illness

Delirium causes a sudden change in how a person thinks and behaves. It can often be treated and many people recover. But it can be distressing for the person and for you, as their carer, family member or friend. On this page, we explain what delirium is, how to help prevent delirium and how to support someone with delirium.

This page is for carers, family members and friends of someone who has delirium. But it might also be useful if you’re living with a terminal illness.

Delirium causes a sudden change in how a person thinks and behave. It’s a sign that there’s something making the person more unwell, like dehydration or an infection. It can often be treated quickly, once the doctor or nurse finds the underlying cause. Delirium becomes more common as someone approaches the end of life.

It can be distressing for the person experiencing it, as well as you and other people close to them. But there are ways to help prevent delirium, support someone to recover, or keep them comfortable if they’re unlikely to recover.

Symptoms of delirium usually start over a few hours or days. They include:

Someone may not have symptoms of delirium all the time – they may come and go. Delirium usually lasts hours or days, but it can last longer.

Symptoms of delirium sometimes get worse at night. This can be because of lack of sleep or daylight.

Lots of things can cause delirium. Causes can include having an infection, being dehydrated, being constipated or being in pain. It can also be caused by side effects of medicines or surgery.

Anyone can develop delirium, but some people are more at risk, including:

It is not always possible to prevent delirium. But there are some things you, along with other carers, family members and friends, can do to make it less likely someone will develop delirium (see How to help prevent delirium or support someone with delirium below). These things are also helpful if someone already has delirium.

If you’ve noticed a recent change in how someone you’re caring for thinks and behaves, it could be delirium. Speak to a healthcare professional, such as the person’s doctor or nurse, as soon as possible.

Identifying delirium early can help healthcare professionals to find and treat the cause more quickly. It also increases the chance of someone recovering from delirium.

Delirium can usually be treated once a healthcare professional has found the cause. Speak to the person’s doctor or nurse if you think they might have delirium. They can arrange for an assessment.

The doctor or nurse will try to find and treat the underlying cause of the person’s delirium. For example, by giving antibiotics to treat an infection, encouraging the person to drink more if they’re dehydrated, or reviewing their medicines, if that’s thought to be the cause.

Medicines can sometimes be used to treat delirium, but only if the person is distressed and other things have not helped. This is because some medicines can make delirium worse or cause other side effects.

You can support someone with delirium by helping to create a calm and supportive environment. This can help them to recover and feel less distressed.

Here are some suggestions for how you can help.

If they usually wear glasses or hearing aids, try to make sure they still use them. Making sure there’s a clock nearby can also help keep them orientated.

Placing familiar photos or favourite items around their room, or using them in conversations, can help keep the person engaged. Playing music or sounds they like can help too – but try to avoid anything too loud.

If they cannot go outside, you could try to put their bed or a chair near a window to get some daylight. Or take a short walk to the lightest part of the room, if they’re mobile.

You should also try to avoid having too many visitors, as it might be loud or overwhelming.

Talk in simple sentences about familiar things. This might be about people they know or activities they enjoy doing.

Try to speak clearly and softly. Check that they’ve understood you and repeat things, if needed.

If they find it difficult to talk, ask questions where they can give ‘yes’ or ‘no’ answers, such as ‘Are you in pain?’. This could be helpful if the person is distressed, and you’re trying to find out why.

If they believe things that are not true, reassure them. If they think somebody is trying to harm them, let them know they are safe.

If they’re having problems with drinking and eating, try to help them in a safe way. You can ask their doctor or nurse for support.

Help them to stay as active as possible. It’s a good idea to speak with their doctor, nurse, or another professional like a physiotherapist if they need help to sit up or move around safely.

Help them to get enough hours of sleep, at the right time of day. For example, keep to or create a bedtime routine and dim the lights at night.

Avoid caffeinated drinks after lunchtime, as these can affect sleep. You could offer decaffeinated drinks instead, such as water or squash.

If the person is approaching the end of life, they may not recover from their delirium. Their doctor, nurse and other healthcare professionals will focus on making sure the person is comfortable.

Sometimes, delirium may cause the person to become agitated towards the end of their life. This is sometimes called terminal agitation. The person may groan or talk in a confused way, or be restless and fidgety. Medication may be needed to keep them calm and comfortable. If you’re worried about this, speak to the person’s healthcare team.

It can be distressing to see someone close to you with delirium, especially if they are thinking and behaving in a different way to usual. You may be worried about their physical health too.

If you’re worried about the person, or if you need support yourself, ask to speak with the person’s healthcare team. You can also ask for guidance about how to support the person with delirium.

To talk to someone about how you’re feeling, call the free Marie Curie Support Line on 0800 090 2309* or email support@mariecurie.org.uk.

You might like to connect with other people in a similar situation to you to get and give support.