Read to understand more about delirium and for tips on how to prevent delirium in elderly patients.
Because assuming your care team will take care of all of it is how we fall into healthcare gaps!
To prevent delirium in the elderly it’s important to start as soon as they reach the hospital. If you’ve read the About page of Navigating with Nurse Derrick, you know about Aunt Steph. A few days after her first trip to the hospital she slipped into delirium. I wish we’d done a better job implementing the steps suggested below before she got that far.
The cause of her delirium could have been her sepsis, her length of stay in the hospital, and/or her medications. We can’t say for sure. But she never bounced fully back.
Luckily, she’d already stated her wishes for who should make decisions for her if she wasn’t of sound mind to make her own decisions. Her siblings stepped up and took control of her medical decisions and made sure her financial obligations were being met. They took good care of her.
I hope you use this as a motivator to figure out who those people are in your life. Communicate your wishes with them. Ask if they’ll be your proxy if such a time comes for you.
If you’re in a position where you’ll be the decision maker for someone else (a parent or grandparent, perhaps?), get those details written out. Be explicit. Don’t wait.
If they’re willing, get the paperwork started now!
- What Is Delirium
- Why Does It Happen
- Tips To Prevent Delirium
- Tips For When Delirium Has Already Started
- Are They Still Decisional?
- Ten Questions For The Care Team
- Resources
- Summary
1. What Is Delirium?
Delirium is a sudden change in the brain. People get confused, can’t focus, and may even see or hear things that are not there. It can pop up in 1 out of 4 older adults in the hospital and in more than 80 % of older folks in the ICU. Keep reading to see how you can prevent delirium in your elderly loved ones.
2. Why Does It Happen?
- Infections, especially sepsis often flip the delirium switch. Many sepsis survivors later report “confusing reality” and fuzzy thinking.
- It doesn’t have to be as serious as sepsis, though. One of the first signs of a urinary tract infection in the elderly is sudden mental status change (delirium).
- It doesn’t have to be as serious as sepsis, though. One of the first signs of a urinary tract infection in the elderly is sudden mental status change (delirium).
- Big moves
- Moving from home to an assisted living facility can spark a change. Or from the facility to a nursing home.
- Moving from home to an assisted living facility can spark a change. Or from the facility to a nursing home.
- Certain medicines
- Sleep aids, strong pain pills, anxiety drugs
- Sleep aids, strong pain pills, anxiety drugs
- Not sleeping, not drinking enough water, or missing hearing aids/glasses
- Pain, constipation, low oxygen, or a room that is too dark or too noisy
- Even just being in the hospital a few days and losing track of a day/night schedule can spark Hospital Acquired Delirium
3. Head-Start Tips to Prevent Delirium
To prevent delirium in anyone (including the elderly), try these simple habits the moment your loved one arrives at the hospital or new facility:
| Habit | Why It Helps |
| Bring glasses, dentures, and hearing aids | Keeps the brain linked to the world around it |
| Keep days bright & nights dark | Resets the sleep-wake clock |
| Daily walks or chair exercises (if safe) | Movement fires up the mind and lungs |
| Hydrate & feed on schedule | Low sugar or dehydration can trigger confusion |
| Familiar photos, music, or a favorite blanket | Anchors memory and lowers stress |
| Ask the team to review meds Daily reminders of the date, time, where they are, and why they’re there | Some drugs quietly worsen delirium risk Keeps them oriented to the reality of their situation |
Grab Your Notebook! Jot down what works and what doesn’t. Small details matter.
4. When Delirium Arrives: Real-Time Care
- Stay calm. Use short sentences. And repeat who you are and where they are.
- Turn on a soft lamp by day; darken the room at night.
- Read the date, time, and a simple headline to ground them. (Reorienting them.)
- Limit TV noise; gentle music is better.
- Keep the call-light in reach and the bed alarm on if they’re fall-prone.
- Huddle with bedside staff every shift change. Use that notebook and ask for ways you can help while staff is not in the room.
5. Decisional vs. Not: Who’s Driving the Bus?
Ask three quick questions:
- Where are you right now?
- What year is it?
- Why are you here?
If your loved one cannot answer two or more, they likely lack decisional capacity. In that case:
- Activate the Health-Care Power of Attorney or Advance Directive.
- This is why you need to have these done in advance and know where your loved one keeps them.
- This is why you need to have these done in advance and know where your loved one keeps them.
- Request a “letter of incapacity” from the physician if decisions must be made fast.
- These are hard to come by. You’ll need two physicians agreeing that they should not be making their own decisions.
- These are hard to come by. You’ll need two physicians agreeing that they should not be making their own decisions.
- Document every choice you sign for in your notebook.
- This helps you keep them informed of your choices once they’re back to their olds selves.
- This helps you keep them informed of your choices once they’re back to their olds selves.
6. Ten Key Questions for the Care Team
- What is the most likely cause of the delirium right now?
- Have we ruled out sepsis or other infections?
- Can any medicines be stopped or switched to lower delirium risk?
- Can we have the AM staff raising the blinds when the sun comes up to allow natural light?
- How are you managing sleep without heavy sedatives?
- What is the mobility plan for today?
- Is pain well-controlled without too much opioid use?
- How will you keep hydration and nutrition on track?
- What safety steps are in place to prevent falls or pulling lines?
- If delirium gets worse, who do I call first and what is the backup plan?
7. Trusted Resources for Families
- MedlinePlus Delirium page: clear overviews and prevention tips (National Library of Medicine).
- Hospital Elder Life Program (HELP) family brochure: 10 practical bedside steps.
- National Institute on Aging research highlights on delirium.
- CDC “Get Ahead of Sepsis” materials: infection signs and next steps.
Take-Home Map
- Prepare: Pack the “brain kit” (glasses, hearing aids, familiar items).
- Prevent: Keep routines as normal as possible: light, movement, hydration, calm voices.
- Plan: Know who is in charge of what if confusion leads to an inability to make sound choices.
- Persist: Use your notebook and the 10 key questions above until the fog lifts.
Preventing delirium in elderly patients when they are going to a new living facility, new health issues, or have a hospital stay is key to keeping up their quality of life. Please utilize the tips above to keep your loved ones in a sound mental state while they continue through life’s hardest chapter.
📄 Want more help? See my posts regarding preparing for a stay in the hospital and managing your care while in the hospital: “What To Bring To the Hospital,” and, “The Notebook.” You can always contact me with questions on the contact page. Thank you for reading! Please share this site with anyone you think could benefit from it! What questions do you have? Do you have any suggestions? Or did this bring up any stories you want to share? Reach out to me through the contact page, or leave a comment below. I’d love to hear from you!
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