Daily Care

Check the environment to ensure that you, the client and those close to them are safe. Remove objects that are a potential hazard, such as knives, cigarette lighters and electrical cords.

Soothe and address anxiety. Clients with delirium are often frightened.

Ensure glasses, hearing aids etc. are close to hand.

Gently and regularly re-orientate the client. Provide visual clues for the time and date, such as a clocks and newspapers.

Try to keep the environment calm and quiet. Minimise noise. If possible, limit the number of people around the client at any one time.

Avoid confrontation.

Try to keep the person in a normal sleep wake pattern by using lights at the appropriate times, reducing noise and stimulation at night. Encourage getting up at the usual time.

Encourage fluid and dietary intake as far as possible.

Explain the cause of the client’s behaviour to relatives and carers and give reassurance.

Check the person’s care plan – or ask healthcare colleagues to do so - to see if they have made any advance wishes about care and treatment they would and would not like to have if they delirium.

Communicate clearly and be consistent when you’re talking to the client.

If you don’t speak the patient’s language, arrange through the healthcare team to have an interpreter.

Delirium will usually require medical and nursing support and medication. Contact your GP, District Nurse or Coordinator if there is a sudden onset of delirium /acute confusion while you are with the client and they are not already receiving treatment.

You may want to use the 4AT Delirium Screening Tool in the Assessment and Management Toolkit to check for likelihood of delirium.

Understanding confusion

The term confusion implies loss of touch with reality. It refers to a range of symptoms including disorientation in time and place, various sorts of inappropriate behaviour, loss of memory, hallucinations, incoherent speech, and paranoia.

Confusion may be caused by dementia, or be due to treatment or complications associated with the person’s illness, including infection, pain, dehydration, and side effects of medicines.

Understanding delirium

Delirium is a sudden deterioration in mental functioning, often associated with underlying frailty and pre-existing disease.

Other terms used to describe delirium include an acute confusional state, agitation, and terminal restlessness.

Delirium is very common towards the end of life and can be very distressing for clients and those close to them.

Depending on the cause, delirium can be reversible, for example, if the person has an infection, urinary retention, or if the delirium is caused by medications.However, delirium that develops in the last few hours and days of life may not be reversible. This is because it’s likely to be due to untreatable causes such as multiple organ failure.

Find out more

Marie Curie: Delirium, agitation and restlessness

Scottish Palliative Care Guidelines: Delirium

Copyright information

Some elements of this section are summarised and adapted from Macmillan Foundations in Palliative Care (FIPC) materials 2020, published by Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, United Kingdom. © Copyright Macmillan Cancer Support 2020, produced by the Digital Health & Care Innovation Centre (DHI). Macmillan Cancer Support accepts no responsibility for the accuracy of the content, which is based on UK practice and guidelines at the date of UK publication; nor for the context in which the content is published; nor for any adaptations made for local use. The content as published in this app/website is solely the responsibility of the Digital Health & Care Innovation Centre, Inovo Building, 121 George St, Glasgow G1 1RD.