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.

Glossary Terms

A drug used to treat infections caused by bacteria and other microorganisms.

In healthcare, a process used to learn about a patient’s condition. This may include a complete medical history, medical tests, a physical exam, a test of learning skills, tests to find out if the patient is able to carry out the tasks of daily living, a mental health evaluation, and a review of social support and community resources available to the patient.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A mineral needed for healthy teeth, bones, and other body tissues. It is the most common mineral in the body. A deposit of calcium in body tissues, such as breast tissue, may be a sign of disease.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.

A mental state in which a person is confused, disoriented, and not able to think or remember clearly. The person may also be agitated and have hallucinations, and extreme excitement.

Extreme mental or physical pain or suffering.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

Higher than normal levels of calcium in the blood. Some types of cancer increase the risk of hypercalcemia.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).

In medicine, a term used to describe a treatment planning approach or team that includes a number of doctors and other health care professionals who are experts in different specialties (disciplines). In cancer treatment, the primary disciplines are medical oncology (treatment with drugs), surgical oncology (treatment with surgery), and radiation oncology (treatment with radiation).

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, supportive care, and symptom management.

An exam of the body to check for general signs of disease.

In medicine, an improvement related to treatment.

A drug or substance used to calm a person down, relieve anxiety, or help a person sleep.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called best practice and standard of care.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Disease that cannot be cured and will cause death.