Hospital Delirium: The Confusion No One Warned You About (and What to Do)
If you’ve ever walked into a hospital room and thought, “This is not my mom,” you are not alone. Clear thinkers can suddenly become confused, anxious, agitated or the opposite: quiet and hard to rouse, after a hospital admission. This is called delirium, and while it’s common, it’s rarely explained to families in plain language. The good news: with early recognition and supportive care, delirium is often temporary and reversible.
This guide will help you spot it, support your loved one, and advocate for what they need, without feeling like you have to become a medical expert overnight.
What is hospital delirium?
Delirium is a sudden change in attention and thinking that develops over hours to days. People can seem “not themselves,” fluctuate during the day, and struggle to stay focused or follow instructions.
Common triggers in the hospital include:
New or interacting medications (especially pain and sedation meds)
Infection, dehydration, untreated pain
Anesthesia and the stress of surgery
Sleep disruption (lights, noises, frequent vitals)
Sensory loss (missing glasses/hearing aids)
Limited mobility and unfamiliar surroundings
Plain-language truth: delirium is a brain stress reaction. Reduce the stressors, and the brain often clears.
Delirium vs. dementia (the quick way to tell)
Onset: Delirium comes on fast (hours–days). Dementia is slow (months–years).
Attention: Delirium disrupts attention (“Can’t stay with me on this”). Dementia affects memory and thinking more than attention early on.
Fluctuation: Delirium changes through the day (better in morning, worse at night). Dementia is steadier day to day.
Reversibility: Delirium is often reversible; dementia is not, though symptoms can be eased.
If what you’re seeing felt “out of the blue,” think delirium first and tell the team what the person’s normal baseline was last week.
Signs to watch for (both kinds)
Hyperactive delirium (easier to spot)
Restlessness, pulling at lines or trying to get up
Agitation, irritability, paranoia or hallucinations
Upside-down sleep (awake all night, sleepy all day)
Hypoactive delirium (often missed)
Very sleepy, withdrawn, unusually quiet
Slower responses, “checked out” look
Eating/drinking less, not initiating conversation
Either pattern is concerning, both are delirium.
What caregivers can do in the hospital (today)
Think in five buckets: Orient. Sleep. Move. Comfort. Clarify.
1) Orient
Bring a big clock, a calendar, photos, and familiar items (blanket, sweater).
Re-introduce where/why: “You’re in Riverside Hospital. You had surgery yesterday and you’re healing.”
Ensure glasses, dentures, hearing aids are in and working.
2) Protect sleep
Ask if overnight vitals can be minimized when safe.
Dim lights, reduce noise, and avoid daytime naps longer than ~30–40 minutes.
Create a bedtime routine (warm blanket, hand lotion, brief quiet music).
3) Get moving (safely)
Request PT/OT; ask for a mobility plan and fall precautions you can help follow.
Encourage short, assisted walks, or sitting in a chair for meals if allowed.
4) Comfort basics
Hydration and regular meals/snacks (as permitted).
Pain management check-in: “Is pain well controlled? Are there lighter options if they’re too drowsy?”
Avoid constipation/urinary retention, ask for prevention plans.
5) Clarify the plan (teach-back)
Before you leave, try:
“Great, to be sure we’re on the same page, here’s the plan in my words: meds, follow-ups, warning signs, and who to call after hours.”
If anything doesn’t match what you heard earlier, say so. It’s not confrontational; it’s safety.
Scripts you can use with the care team
Screening: “Could this be delirium? Are you using a quick screen for it?”
Med review: “Which medications could be clouding their thinking? What can we simplify?”
Sleep: “Can we reduce nighttime disturbances when it’s medically safe?”
Mobility: “What’s today’s safe mobility goal? Can PT/OT leave us three in-room exercises?”
Discharge: “What do we do if confusion is the same or worse at home this week?”
A 5-minute caregiver routine (repeat 2–3x/day)
Re-orient with the where/why/what’s next script.
Put in glasses/hearing aids; tidy the bedside.
Hydration check; offer sips if allowed.
Two minutes of gentle movement (ankle pumps, seated marches) if permitted.
Quick teach-back with staff or each other: restate the plan.
Small, consistent actions add up.
After discharge: what to expect
Delirium often improves over days to weeks. People may feel more themselves in the morning and foggier at night at first. Keep routines simple and familiar. Track:
Sleep quality
Appetite/hydration
Mobility and steadiness
Orientation (knows day/place)
Med changes and pain levels
Schedule follow-ups as instructed. If recovery stalls or regresses, call sooner.
When to call urgently
Worsening confusion or agitation
New fever, uncontrolled pain, shortness of breath
Not eating/drinking, signs of dehydration
New falls or inability to safely walk to the bathroom
Hard to wake, or you can’t keep them safe at home
Trust your gut. If it feels unsafe, seek care.
