Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

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Overview

Delirium is a term used to describe a serious disturbance in mental abilities that causes a person to become severely confused. A person with delirium cannot think clearly, has trouble paying attention, is less aware of what is happening around them, and may see or hear things that are not there.

Delirium often develops suddenly, typically within a few hours or days. Although a variety of factors may contribute to the development of delirium, disturbed sleep is an important factor. Noise in the hospital, particularly in the intensive care unit (ICU), can make it difficult for a person to get enough sleep. Other risk factors for delirium include pain, certain medications, and a patient’s medical condition.

Delirium is often temporary, lasting a few days to a week. However, mental function may not fully recover for several weeks.

Delirium is different from dementia, although dementia can increase the risk for delirium in older patients. While delirium is a temporary disturbance in thinking that develops suddenly, dementia is a permanent condition that develops over months or years.

Delirium is divided into 3 types based on a person’s behavior. They are:

Hyperactive delirium. Patients with hyperactive delirium may experience hallucinations and may become agitated, restless, and disoriented. 

Hypoactive delirium. Patients with hypoactive delirium are sluggish, apathetic, subdued, and respond slowly to questions. Hypoactive delirium occurs most often in older patients.

Mixed delirium. Patients with mixed delirium experience periods of both hyperactive and hypoactive delirium. For example, a person may be subdued during the day and become agitated at night.

Causes

Delirium is caused by a disruption in how the brain normally receives and sends signals. The brain may not receive or use enough oxygen, or chemical changes may occur in the brain.

A combination of factors likely come together to make the brain susceptible to this impairment. Sleep disturbance is one of those factors and is common in patients with delirium.

For patients in the hospital, particularly those in the intensive care unit, it is difficult to maintain a normal sleep pattern. A patient may sleep during the day and be awake for several hours at night. A disrupted sleep pattern can trigger the brain to malfunction.

Factors that may contribute to the development of delirium include:

  • Having a medical condition that results in a hospital stay
  • Use of certain medications, such as medicines to treat pain, sleep disorders, anxiety, and depression
  • Treatment with multiple medications
  • Dehydration
  • Electrolyte imbalance
  • Infections, such as pneumonia or urinary tract infections
  • Sustained sleep deprivation
  • Having multiple medical problems or procedures
  • Withdrawal from alcohol or sedative drugs

Risk Factors

Patients are more likely to develop delirium if they:

  • Have dementia or another cognitive disorder
  • Are sleep-deprived
  • Are older than 65
  • Are male
  • Have a history of delirium
  • Have untreated pain
  • Have a severe illness such as heart failure
  • Have an infection
  • Have poor hearing and eyesight
  • Are treated with multiple drugs
  • Have poor nutrition
  • Have limited ability to get out of bed
  • Abuse alcohol or drugs
  • Have had surgery, particularly heart or hip surgery

Symptoms

Symptoms of delirium develop suddenly over a few hours to a few days. The symptoms may fluctuate throughout the day and there may even be times when no symptoms are present.

Some symptoms of delirium involve thinking, while others involve behavior. Symptoms of delirium include:

  • Inability to remain focused on a topic or follow directions
  • Easily distracted
  • Limited response to what is going on around them
  • Disorientation, such as not knowing where they are or the time of day
  • Difficulty reading or writing
  • Rambling or incoherent speech
  • Problems with recalling words and understanding speech
  • Memory problems, especially memory of recent events
  • Change in sleeping habits
  • Extreme emotions, such as agitation, anxiety, depression, fear, or aggression
  • Being withdrawn, lethargic, or subdued
  • Seeing or hearing things that are not there (hallucinations)
  • Tremors or other movements caused by nervous system changes

It is important to understand the difference between symptoms of delirium and dementia, particularly because people with dementia often also develop delirium. Here are some of the main differences:

Symptoms of delirium develop suddenly over a few hours or days, while dementia gradually worsens over a long period of time.

Delirium causes a significant inability to stay focused and pay attention. Someone in the early stages of dementia can remain alert overall.

Symptoms of delirium can fluctuate significantly. The level of impaired thinking and memory remains somewhat constant throughout the day for someone with dementia.

Diagnosis

If a patient is experiencing symptoms of delirium, we use a variety of methods to evaluate their mental and physical state. If a patient is at high risk for delirium, an assessment for delirium may be done.

Patients with delirium are often confused and unable to answer questions about medical history or symptoms. Therefore, family members and caregivers are often needed to provide accurate information. We also consult notes made by the nursing staff that document periods of unusual behavior, disorientation, or hallucinations.

Treatment

The treatment of delirium starts with addressing the underlying factors that triggered the confused mental state. For example, this may mean treating an infection, minimizing or stopping particular medications, or adequately treating pain.

The next step is to create the best possible environment to help the brain recover. The involvement of family members and caregivers is extremely important. The following approaches may be used:

  • Use clocks and calendars to help with orientation.
  • Family members and caregivers regularly tell the person what day and time it is, where they are, and what’s happening around them. Talking about current events and playing word games can also help.
  • Create a comfortable environment by placing familiar objects from home in the hospital room.
  • Get out of bed and walk at least a few times a day. Certain exercises may also be recommended.
  • Reestablish a regular sleep pattern by keeping the blinds open during the day to encourage daytime alertness and turning the lights off at night. We minimize the noise at night to allow for uninterrupted sleep. We also make efforts not to wake you or your family member in the early morning hours unless absolutely necessary.
  • Wear eyeglasses, hearing aids, and dentures if needed.

If the above methods are ineffective or if a person experiences severe agitation or paranoia, medications may be used to manage delirium.

Prevention

Many of the methods used to treat delirium can also be used to help prevent it. Some of the ways we minimize risk for delirium include adequately controlling pain, reducing noise in the hospital unit at night, checking regularly for signs of delirium, and helping a patient get up and move every day.

There are also things you and your family can do to lower the risk of delirium, including:

  • Keep a list of your medical conditions, medications, and allergies.
  • Be as active as possible during the day, such as walking to the bathroom or down the hall a few times a day. Range-of-motion exercises can also be helpful.
  • Keep the blinds open during the day to be aware that it is daytime, and turn the lights off at night.
  • If needed, wear ear plugs at night to block out surrounding hospital noise.
  • Drink plenty of fluids and eat a healthy diet. Have a family member or caregiver present during meals for assistance and companionship.
  • Wear eyeglasses, hearing aids, and/or dentures.
  • Engage in regular conversation with loved ones to stay oriented to the current time, place, and what is happening.
  • Do crossword puzzles or play other mind-stimulating games.
  • Surround yourself with a few familiar objects from home. These items may include a blanket, family photos, or a favorite book.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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