Treatment of the Symptoms of Delirium by Changing the Patient's Surroundings
Treatment of the Causes of Delirium
Treatment of the Symptoms of Delirium with Medication
Delirium and Sedation

Patient and family concerns are addressed when deciding the treatment of delirium. Deciding if, when, and how to treat a person with delirium depends on the setting, how advanced the cancer is, the wishes of the patient and family, and how the delirium symptoms are affecting the patient.

Monitoring alone may be all that is necessary for patients who are not dangerous to themselves. In other cases, symptoms may be treated or causes of the delirium may be identified and treated.

Controlling the patient's surroundings may help reduce mild symptoms of delirium. The following changes may be effective:

• Putting the patient in a quiet, well-lit room with familiar objects.
• Placing a clock or calendar where the patient can see it.
• Reducing noise.
• Having family present.
• Limiting changes in caregivers.

To prevent a patient from harming himself or herself or others, physical restraints also may be necessary.

The standard approach to managing delirium is to find and treat the causes. Symptoms may be treated at the same time. Identifying the causes of delirium will include a physical examination to check general signs of health, including checking for signs of disease. A medical history of the patient’s past illnesses and treatments will also be taken. In a terminally ill delirious patient being cared for at home, the doctor may do a limited assessment to determine the cause or may treat just the symptoms.

Treatment may include the following:

• Stopping or reducing medications that cause delirium.



• Giving fluids into the bloodstream to correct dehydration.



• Giving drugs to correct hypercalcemia (too much calcium in the blood).



• Giving antibiotics for infections.

Drugs called antipsychotics may be used to treat the symptoms of delirium. Drugs that sedate (calm) the patient may also be used, especially if the patient is near death. All of these drugs have side effects and the patient will be monitored closely by a doctor. The decision to use drugs that sedate the patient will be made in cooperation with family members after efforts have been made to reverse the delirium.

The decision to use drugs to sedate the patient who is near death and has symptoms of delirium, pain, and difficult breathing presents ethical and legal issues for both the doctor and the family. When the symptoms of delirium are not relieved with standard treatment approaches and the patient is experiencing severe distress and suffering, the doctor may discuss the option to give drugs that will sedate the patient. This decision is guided by the following principles:

• Healthcare professionals who have experience in palliative care make repeated assessments of the patient’s response to treatments. The family is always included.



• The need to use drugs that sedate the patient is evaluated by a multidisciplinary team of healthcare professionals.



• Temporary sedation should be considered.



• A multidisciplinary team of healthcare professionals will work with the family to ensure that the family's views are assessed and understood.

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