Confusion (delirium) is a change in a person’s ability to think clearly. There may be trouble recognizing familiar people and places or knowing what day it is. Memory, judgment, and decision-making may also be affected. In severe cases, the person may have limited or no response to being spoken to. Confusion usually appears over a few days and can vary throughout the day. It can last weeks to months or longer, depending on the cause.

Confusion is usually a sign of an underlying problem. It may occur suddenly. Or it may develop gradually over time. Causes of confusion include brain injury, stroke, heart disease, low blood sugar in diabetes, medicines, alcohol, withdrawal from certain medicines or illegal drugs, and infection. Confusion can also be a sign of low blood oxygen levels, dementia, or a mental illness. In older adults, an infection such as a urinary tract infection or pneumonia is a common cause of confusion.

Treatment will depend on the cause of the problem. If infection is found, your loved one may need antibiotics. If the issue is a medicine, stopping the medicine may help. Thiamine supplement may help with very little risk of side effects. Benzodiazepines may help people who are undergoing alcohol withdrawal. If confusion is chronic, your loved one may need medicines to treat forms of dementia.

Home care

  • Be sure someone is with the confused person at all times. They should not be left alone or unsupervised.

  • Tell the healthcare provider about all medicines that the person takes. These include prescription, over-the-counter, herbs, and supplements.

  • Dehydration can increase confusion. Ask the healthcare provider how much fluid the person should be drinking. Offer liquids and ensure that they are taken.

  • Keep all medicines in a secure place under the caregiver’s control. To prevent overdose, a confused person should take medicines only under the supervision of a caregiver.

  • To help a person with confusion:

    • Establish a daily routine. Change can be a source of stress for someone with confusion. Make and keep a time schedule for common tasks such as bathing, dressing, taking medicines, meals, going for walks, shopping, naps and bed time. Make sure that the person has glasses and hearing aids if needed.

    • Don't use physical restraints.

    • Speak slowly and clearly with a gentle tone of voice. Use short simple words and sentences. Ask one question at a time. Don't interrupt, criticize, or argue. Be calm and supportive. Use friendly facial expressions. Use pointing and touching to help communicate. If there has been loss of long-term memory, don't ask questions about past events. This would only cause frustration for the person.

    • Use lists, signs, family photos, clocks and calendars as memory aids. Label cabinets and drawers. Try to distract, not confront, the person. When they become frustrated or upset, redirect attention to eating or some other activity of interest.

    • If this proves to be due to a permanent condition, talk to the healthcare provider or a lawyer about getting a Power of Attorney for healthcare and for financial decisions. It's best to do this while the person can still sign legal documents and make decisions. Otherwise, a court order will be required.

Follow-up care

Follow up with the person's healthcare provider or as advised for further testing or changes in medical care.

When to seek medical advice

Call the healthcare provider for any of the following:

  • Frequent falling

  • Refusal to eat or drink

  • Increased drowsiness

  • Nausea or vomiting

  • Unexplained fever over 100.4º F (38.0º C), or as directed by the healthcare provider

Call 911

Call 911 right away if any of the following occur:

  • Violent behavior or behavior too hard to manage at home

  • New hallucinations or delusions

  • Severe headache, numbness or weakness of the face, arm, or leg

  • Slurred speech or trouble speaking, walking, or seeing

  • Fainting spell, dizziness, or seizure

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