Sudden confusion in an older adult after a crash
A geriatrician and a trauma nurse explain delirium
After an injury or a hospital stay, an older adult may suddenly seem confused, sleepy or restless. They may not seem like themselves. This may be delirium, a sudden state of confusion. It can come and go over the course of a day. Report it if the person grows quiet and withdrawn, just as you would report agitation. [1, 2]
Sudden confusion can have causes that can be treated. These include illness, pain, dehydration, poor sleep and medicines. It needs prompt medical attention. [1, 2]
Tell the team what the person is usually like
Family members often spot a change first. Tell the nurse or doctor what the person could do before the crash. Say when the new behavior started and whether it comes and goes. Mention any head injury. Ask for an evaluation now instead of waiting for the next routine visit. [1, 2]
Share examples. The person may not recognize someone familiar or may lose track of a conversation. Unusual sleepiness and seeing things that aren’t there are other examples. [1, 2]
Help them know where they are
Speak calmly and give short reminders about where they are and what’s going on. Bring their glasses, hearing aids and dentures if they usually use them. A familiar face, daylight, a clock and a steady sleep routine can help. Ask the care team how to help with eating, drinking and moving around safely. These steps support care. The team still needs to look for the cause. [1, 2]
Plan a safe trip home
If the confusion hasn’t cleared, ask whether the person can handle medicines, stairs, meals and appointments. Find out who will keep an eye on them and when their thinking will be checked again. A new or worsening change in mental state needs urgent medical help. That’s especially so if it comes with weakness, a severe headache, trouble breathing or fever. [1, 2]
Questions to put to the care team
- What might be causing this sudden change?
- Which medicines or health problems are you looking at?
- What help will be needed at home tonight?
Note when they last seemed like themselves
Write down the last time the person acted like their usual self. [1]
Sources and further reading
This article gives general information from geriatric medicine and trauma nursing. Sudden confusion needs a prompt medical exam. Don’t write it off as normal aging, and don’t change medicines without a doctor’s advice.
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