A delirium scenario

This scenario is presented for educational purposes only. It is not intended as medical advice. If you believe your loved one is experiencing delirium, contact a health professional immediately.

 

Margaret is an 83 year old woman who lives with her husband, Bert. They are managing pretty well. Bert has a bad heart, so he gets out of breath easily, but he does what he can to help around the house. Margaret had a stroke a few years back, and her memory hasn’t been quite the same since. Bert takes care of paying the bills, lays out the pills for the both of them, keeps an eye to make sure the burners are turned off, and they do the shopping together. They take walks around the apartment complex together, for exercise.

One Saturday, Margaret says she feels tired and wants to take a nap after lunch. This is unusual for her, as she is not a napper, and they usually take one of their walks on Saturdays after lunch. She wakes up with a start 30 minutes later; she struggles to get off the couch and rushes to the bathroom. She loses some urine on the way, and it soaks down the leg of her pants. She goes into the bedroom to change her pants. Bert finds she still smells of urine, and finds out that she only changed her pants, not her underwear. Margaret seems confused and upset, and calls Bert “Richard” by mistake, which is their son’s name. She says “Richard, what are we having for lunch”, when in fact she and Bert have already had lunch.  Bert reminds her they’ve already eaten, and she gets angry and argues with him.  Bert is frightened by this new onset of confusion.

This is delirium.

Although Margaret has had a less-than-perfect memory since her stroke, this is a big, sudden change. This is not the same Margaret as yesterday. The first thing that Bert needs to do is recognize that this change in her means that Margaret might be having a new medical problem that is causing the confusion, which is called delirium. He should bring her to the doctor’s office. If the doctor’s office is closed, then he should bring her to a walk-in clinic or the emergency room.

It turns out that Margaret has a bladder infection. She is sent home from the emergency room with a prescription for an antibiotic. The doctor in the emergency department tells Bert that she may still have some confusion for a few days or even weeks, even after the antibiotic has started working on her bladder infection. Delirium can take a little while to clear up, even when the right treatment for its cause (in her case the infection) is started.