Risk Factors for Delirium
Delirium is a sudden change in a person’s mental state , making them confused, disoriented, or unable to focus. It can be caused by different medical conditions, infections, or medications. Some people are more at risk of developing delirium than others.
Common Risk Factors:
- Age 65 or older – Delirium is more common in older adults due to changes in brain function and overall health.
- Infections – Urinary tract infections ( UTIs ), chest infections, or any other infections can trigger delirium.
- Cognitive conditions – Having dementia, memory problems, or depression increases the risk.
- Past episodes of delirium – If someone has had delirium before, they are more likely to get it again.
- Hip fracture – This can lead to pain, stress, and reduced mobility, which may trigger delirium.
- Hearing or vision problems – If someone struggles to see or hear properly, they may become confused more easily.
- Serious illness – Conditions that cause severe weakness or organ failure (e.g., heart disease, kidney failure, cancer) increase risk.
- Multiple health issues – Having several medical conditions at the same time makes delirium more likely.
- Alcohol or drug use – Drinking heavily, using drugs, or suddenly stopping these substances can lead to delirium.
Case Study: Mary
Mary is a 79-year-old lady. She has a history of urinary tract infections (UTIs). She lives with her 82-year-old husband and is also cared for by her daughter, who lives locally. Mary has a diagnosis of Alzheimer’s Dementia. She has been doing very well and her family has had no concerns up to now.
Over the past week, Mary’s sleep patterns have been disturbed. She falls asleep well but wakes up at 2 or 3 am, believing it’s morning. She gets annoyed when her husband tries to reassure her. During the day, she is either very sleepy or restless. Sometimes, she is clear-headed, but other times, she seems confused.
Over the past week, Mary’s sleep patterns have been disturbed. She falls asleep without issue, but wakes at 2 or 3 am, thinking it’s morning and time to get up - she gets irritable with her husband when he tries to reorientate her. During the day, the family has noticed that she is either sleeping or awake and very agitated. They report short periods during the day when she is more lucid.
Her family have also noted that:
- She believes someone is trying to break into the house.
- She refuses to take her medication, thinking her husband is poisoning her.
- She isn’t eating or drinking properly.
- She is trying to pick things up off the floor that aren’t there.
Her symptoms started suddenly and are getting worse . Concerned, her family brings MAry to the GP.
Think Spot: Based on Mary’s symptoms, could this be delirium?
Answer: Yes.
Mary has several risk factors for delirium, including her age (over 65), a history of UTIs , and a dementia diagnosi s. Her symptoms appeared suddenly* and change throughout the day ( fluctuating confusion ). She is also hallucinating and feeling paranoid , which are common signs of delirium.
*Taking a history is very important so as not to confuse delirium with the non-cognitive symptoms of dementia, which have a more insidious (slow) onset
More About the Risk Factors of Delirium
Understanding these risk factors can help prevent or detect delirium early:
1. Advanced Age Older adults (65+) are more vulnerable due to changes in brain function and higher rates of medical issues.
2. Infections Conditions like UTIs , pneumonia (lung infection) , or sepsis (a life-threatening infection) can trigger delirium by causing inflammation (swelling and irritation inside the body), which affects brain function.
3. Dementia or Cognitive Impairment People with dementia are at higher risk of delirium because their brains are already struggling with memory and thinking skills. A sudden illness or change in surroundings can cause worsening confusion and contribute to delirium.
4. Sensory Impairments If someone can’t see or hear well , they may struggle to understand what’s happening around them, leading to disorientation (feeling lost or confused) and contributing to delirium.
5. Alcohol or Drug Use Alcohol and drug use can lead to delirium, either during intoxication or withdrawal phases. Stopping alcohol suddenly can cause alcohol withdrawal delirium (delirium tremens) , a serious condition that can cause shaking, confusion, and hallucinations.
6. Serious Illness Conditions like heart disease , lung disease , kidney failure , or cancer can directly affect, or cause chemical imbalances in the body which may affect, brain function and lead to delirium.
7. Medications Certain medications can increase the risk of delirium, including:
- Sedatives (medications that help with sleep or anxiety)
- Opioids (strong painkillers like morphine)
- Anticholinergics (drugs that treat allergies or bladder problems but may cause confusion)
- Antipsychotics (used for severe mental health conditions)
- Polypharmacy (taking many different medications at the same time)
8. Poor Sleep Not getting enough sleep or disruptions in the sleep-wake cycle can make it harder for the brain to function properly and contribute to delirium. This is common in hospitals, where noise, medical treatments, and discomfort can disrupt sleep.
9. Dehydration or Poor Nutrition Not drinking enough fluids or getting the right nutrients can lead to electrolyte imbalances (too much or too little of important minerals like sodium or potassium), which can cause confusion and increase the risk of delirium.
10. Stressful Events or Hospitalisation Major events, like surgery , trauma , or time in an intensive care unit , can be overwhelming and increase the risk of delirium, especially for those already vulnerable.
Final Thoughts
Just because someone has risk factors doesn’t mean they will develop delirium - but it’s important to watch for the warning signs. Healthcare professionals and caregivers can help by staying alert to sudden changes in behaviour and taking steps to prevent delirium when possible.