On Monday your mother was herself. By Wednesday she is calling you by her sister’s name, dozing at noon, and agitated at night. A family that already lives with dementia may read this as the dementia getting worse. A family without a diagnosis may wonder whether this is how dementia starts. In both cases, the first question about a change this fast is whether she is sick.
This guide is for any family member or caregiver who notices a sudden change in an older adult’s thinking.
What delirium is
MedlinePlus, from the National Library of Medicine, defines delirium as “sudden severe confusion due to rapid changes in brain function that can occur with physical or mental illness” (MedlinePlus). Two features help families recognize it:
It comes on quickly. Hours or days, compared with the months and years over which dementia usually changes.
It comes and goes. A person may be alert in the morning and confused at night, or sleepy and then agitated.
Delirium can happen to someone who has dementia and to someone who does not.
Common causes
MedlinePlus lists infections, including urinary tract infections and pneumonia, and certain medicines, including some pain medicines and sedatives, among the causes.
What to do today
Call the person’s clinician the same day and say the words “sudden change in thinking.” Ask whether the person should be seen today.
Call 911 if the person cannot be woken, is struggling to breathe, or has had a fall with a head injury. Also call 911 for signs of a stroke, such as a drooping face, weakness on one side, or slurred speech.
Bring the medication list, including anything started, stopped, or changed in the past few weeks.
Bring what you observed: when the change started, whether it comes and goes, and anything else new, such as fever, pain, a change in urination, not eating, or not drinking.
OPA’s free Observation Log keeps those facts in one place, and the Medications and Allergies sheet keeps the current list ready.
While the person recovers
Ask the clinician what to watch for, what will help the person recover, and when to call back.
If the person needs more help at home during recovery, plan for the hours when they are most confused. MedlinePlus notes that alertness is usually lower at night.
When the family is the only one who can see it
Sudden confusion is easy to miss when no single person sees the whole week. The Weakest Link, Book I of the Operational Reliability Series, follows a family through an acute healthcare crisis. The story includes a missed infection and the confusion that followed. Read about the book.
A first step this week
Agree as a family on one rule: anyone who notices a sudden change in thinking calls the clinician that day and tells the rest of the family the same evening.
If your family member needs extra support at home during recovery, see how care starts at OPA.
This is general information, not medical advice. A sudden change in thinking needs a clinician’s evaluation. Call 911 for an immediate emergency.
For a reliable next step, use MedlinePlus information about delirium for the official details, then use short-term recovery support when your family needs to organize support at home.
For a related decision, CDC stroke-signs guidance can help frame the question, and this site’s observation-log guide offers a practical next step.
Clinical guidance for the home plan
The MedlinePlus's delirium overview describes a sudden change in mental state. Use this guidance to prepare questions for the treating team; the person's own clinical instructions determine the care plan.
The MedlinePlus's delirium encyclopedia guidance explains that delirium can occur alongside chronic dementia. Use this guidance to prepare questions for the treating team; the person's own clinical instructions determine the care plan.
Turn the instructions into a shared home plan
Use the Care Coordination Grid from OPA's Knowledge Center to name who handles appointments, daily routines, and the next handoff. Keep the treating team's instructions and contact details alongside the schedule. Confirm the required tasks and schedule before care starts.
