Sudden changes to a persons normal behaviour

such as becoming withdrawn, memory problems,

or confusion and restlessness, may be a condition
called delirium.
Delirium is not madness or dementia, or a
disease.
It is a common experience in palliative care,
affecting nearly half of patients with advanced
cancer, and up to 9 out of 10 patients in the last
hours or days of life.
Delirium is reversible in approximately half of
people with advanced illness because it has an
underlying and treatable physical cause.
Family and friends are often the first to notice the
subtle changes because they know what is normal
for the person. They are very important in the
management of delirium as they can often ground
the person and lessen any distress.
How do you recognise delirium?
Two important things that set delirium apart
from problems with similar symptoms, like
depression, tiredness, or dementia, are that it
comes on suddenly in a matter of hours or days
and it usually comes and goes over the course of
the day. The person may be relatively calm and
normal during the day, but restless and confused
in the evening.
The person with delirium may:
be suddenly different to their normal self;
be quiet, withdrawn and sleepy or very
restless and disturbed or fluctuate
between the two;
lose the ability to think clearly and
logically, or concentrate;
be unable to remember recent events and
conversations;
speak in a rambling and incoherent way;
talk about the past as though it were the
present;
be quite moody and unstable, for example
showing happiness, sadness, or anger all
within a short space of time;
see things that arent there, but are real
to them (hallucinations) and believe things
that arent true (delusions);
wander around without purpose;
have changes to their sleeping habits, be
awake at night and drowsy during the day;
or
lose control of their bladder and bowels.
The doctor or nurse should be advised of any
changes as soon as possible.
What causes delirium?
Common causes, in palliative care patients, are
Constipation;
A chest, urine or skin infection;
Delirium
Fact sheet


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Unrelieved pain;
An imbalance in mineral and salt levels in
the blood;
A change in medication type or dose;
Too high a dose of pain medication for
the persons current level of pain;
Withdrawal from medication or alcohol;
Emotional distress;
Progressing illness e.g. failing kidneys,
liver, heart or lungs;
Lack of sleep; or
Cancer of the brain or brain injury.
Poor eyesight or hearing, or depression, are
other factors which can make people prone to
delirium.
What can be done about delirium?
Chances of recovery from delirium are best if it is
diagnosed and treated early.
It is important to:
Find and treat the underlying cause. In
palliative care there is often more than
one cause;
Maintain a calm, stable and safe
environment;
Closely observe and frequently review the
persons behaviour; and
Ensure the persons safety.
Sometimes it is not possible to identify a direct
cause and the care is aimed at reducing distress
for everyone.
Sedative medication may be prescribed to help
the person relax, relieving agitation, restlessness
and distress. The medication most commonly
used is haloperidol (Serenace) because it helps to
clarify the clouded thought processes that people
have.
Caring for someone with delirium
Caring for someone who has delirium can be
difficult and tiring, whether you are a family
member, health professional or other carer.
A major part of caring for someone with delirium
is the non medical care. This can reduce the
severity of the symptoms and make the
experience less distressing.
Some people fear insanity more than death.
Reassure the person that they are not going mad,
and to you they are still the same person, even if
their condition makes them say or do odd things
at times.
A calm and quiet setting is best; but the person
should not be isolated or left alone for too long.
People with delirium need the reassurance of
having the company of familiar people, familiar
belongings, and where possible being in familiar
surroundings. In an unfamiliar environment
objects from home (e.g. photos, blanket, bed-side
clock) can be helpful.
Night lights and familiar soothing music may be
beneficial.
You may need to remind the person of where
they are and who you are.
Speak slowly and clearly so the person can keep
up with your thoughts. People with delirium can
only cope with one thing at a time.
Dont argue with or challenge a person who is
rambling or having delusions. If the content of
what the person is saying doesnt make sense,
respond to the feeling or mood. It is better to
relieve anxiety than to suggest to the person they
are talking nonsense.
Sight and hearing loss can make confusion worse.
If the person normally wears glasses and hearing
aids, make sure they are being worn.

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Delirium in the last few days of life
Delirium at the end of life is often called terminal
delirium. It can be mild or severe.
It is a common part of the dying process and
occurs in the majority of palliative care patients
towards the end of their life; persisting till death
in about two thirds of patients. It is thought to be
due to body functions slowing down and getting
out of balance.
Investigations at this time may be intrusive and
burdensome. The focus of care is looking after
the safety and comfort of the patient and family.
Knowing this, it is a good idea to talk to the
person about their wishes, and say anything
important to them earlier rather than later in
their illness. This will avoid feelings of frustration
and regret if the person develops an irreversible
delirium and the opportunity is lost.
Help from the health care team
The doctor will concentrate on finding and
treating the cause/s of delirium. They can order
any medication necessary to relieve or manage
the symptoms.
Sometimes the doctor may advise a short
admission to a hospice or hospital where
treatment can be given and medications can be
altered quickly if necessary.
Nurses can provide guidance in the best ways to
support the person with delirium and help with
managing the medication.
Hospice volunteers can support the family by
helping with practical tasks like shopping, or
sitting with the person to give the family a break.
The social worker can support both the carer
and the patient. Carers may need to talk to
someone about the feelings of distress they
experience watching someone they care for go
through delirium. The person who has
experienced delirium may have unpleasant
memories of delusions or hallucinations, and will
benefit from support and counselling.
Related Fact Sheets
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CONTACT DETAILS
Palliative Care South
Ph: 03 6224 2515 or palliativecare.south@dhhs.tas.gov.au
Palliative Care North
Ph: 03 6336 5544 or palliativecare.north@dhhs.tas.gov.au
Palliative Care North West
Ph: 03 6440 7111 or palliativecareservicenw@dhhs.tas.gov.au