Create a patient education handout about hyperactive hospital‑acquired delirium.

Understanding Hyperactive Hospital-Acquired Delirium: A Guide for Patients and Families

What Is Hyperactive Delirium?

Hyperactive delirium is a sudden change in brain function that develops during your hospital stay, causing restlessness, agitation, and confusion. 1, 2 This is a medical emergency that requires immediate attention from your healthcare team. 2

• Delirium represents acute brain failure that develops over hours to days, not weeks or months. 2
• The hyperactive type specifically involves increased movement, restlessness, and agitation rather than sleepiness or withdrawal. 1
• Symptoms fluctuate throughout the day, often worsening in the evening and at night. 1, 2
• This condition affects up to 80% of patients on breathing machines in intensive care units and 20-25% of older adults on general hospital floors. 1, 3

Recognizing the Signs

Core Features You or Your Family May Notice

• Sudden confusion that started within the past few hours or days, not gradually over weeks. 2
• Difficulty paying attention – easily distracted, cannot focus on conversations, appears withdrawn or absent. 2
• Restlessness and agitation – constant movement, pulling at tubes or IV lines, trying to get out of bed unsafely. 1
• Rapid or pressured speech that may be disorganized, rambling, or switching topics frequently. 4
• Heightened arousal – appearing overly alert, startled easily, or hypervigilant. 1

Other Common Symptoms

• Seeing or hearing things that aren't there (hallucinations), often visual in nature. 1
• False beliefs (delusions) that come and go. 1
• Disorientation – not knowing the date, where you are, or sometimes who you are. 2
• Sleep problems – staying awake all night, sleeping during the day, or having frightening dreams. 1, 2
• Emotional changes – fear, anxiety, anger, or rapid mood swings. 1
• Calling out, screaming, or moaning. 1

Why Does This Happen in the Hospital?

Delirium is almost always caused by multiple factors working together, not just one problem. 1

Common Triggers in Hospitalized Patients

• Infections – urinary tract infections and pneumonia are the most frequent causes. 1, 5
• Medications – pain medications (opioids), sedatives, and drugs with anticholinergic effects are major contributors. 1, 5
• Dehydration or electrolyte imbalances – low sodium, abnormal calcium, or inadequate fluids. 1, 2
• Low oxygen levels or breathing problems. 1, 5
• Surgery and anesthesia – over 20% of high-risk surgical patients develop delirium. 2, 5
• Pain that is not adequately controlled. 1
• Sleep disruption from hospital noise, lights, and frequent interruptions. 1

What Your Medical Team Will Do

Immediate Assessment

• Your nurses will check you regularly (every 8-12 hours) using a validated screening tool to catch delirium early. 5
• Your doctor will talk to family members who know your normal mental state to understand what has changed. 2, 5
• Blood tests will check for infections, electrolyte problems, kidney and liver function, and blood sugar levels. 5
• Urine tests will look for urinary tract infections. 5
• A chest X-ray may be done to check for pneumonia. 5
• All your medications will be reviewed, especially any new ones or recent dose changes. 5

When Brain Imaging Is Needed

• A CT scan of your head is necessary if you have new weakness on one side, recent falls or head injury, new seizures, or are on blood thinners. 5
• Most patients with a clear cause (like infection or medication effect) and no neurological problems do not need brain imaging. 5

Treatment Approach

First-Line Strategies (Non-Medication)

The primary treatment focuses on identifying and fixing the underlying medical problems while keeping you safe and comfortable. 1, 6

• Treating the root cause – antibiotics for infection, stopping problematic medications, correcting dehydration or electrolyte problems. 2, 6
• Frequent reorientation – staff and family repeatedly telling you where you are, what day it is, and what is happening. 1, 6
• Restoring your sleep-wake cycle – keeping lights on during the day, reducing noise and lights at night, avoiding unnecessary nighttime interruptions. 1, 6
• Early mobilization – getting you out of bed and moving as soon as medically safe. 1, 6
• Ensuring you have glasses and hearing aids if you normally use them. 1, 6
• Adequate nutrition and hydration – making sure you eat and drink enough. 1, 6
• Pain control – managing discomfort without oversedating you. 1, 6
• Familiar objects and family presence – having family photos, familiar items, and loved ones at the bedside when possible. 6

When Medications May Be Used

• Antipsychotic medications are reserved only for patients who pose an immediate danger to themselves or others despite all non-medication interventions. 1, 3
• These medications do not cure delirium but may temporarily reduce dangerous agitation. 1
• Any antipsychotic prescribed should be at the lowest dose for the shortest time possible, with a clear plan to stop it. 3
• Sedatives like benzodiazepines typically worsen delirium and are avoided unless you are withdrawing from alcohol. 1

What to Expect

Timeline and Recovery

• Most hospital-acquired delirium lasts about one week if the underlying causes are identified and treated. 1
• Symptoms fluctuate hour-to-hour, so you may have periods of clarity mixed with confusion. 2
• Recovery can take longer in older adults or those with pre-existing memory problems. 1
• Some patients experience lingering cognitive problems for months after the delirium resolves. 5

Serious Risks If Untreated

• Delirium is associated with doubled risk of death if not recognized and treated promptly. 5
• Patients with delirium have longer hospital stays and higher rates of needing nursing home placement. 1, 6
• Delirium increases the risk of developing permanent memory problems (dementia) later. 2

How Family Members Can Help

• Alert the nurse immediately if you notice sudden changes in your loved one's attention, awareness, or behavior. 6
• Provide information about their normal mental function and personality to help staff recognize changes. 2, 5
• Bring in glasses, hearing aids, and familiar objects from home. 6
• Help with reorientation by calmly reminding them where they are and what is happening. 6
• Encourage them to get out of bed and move around when the medical team says it is safe. 6
• Avoid arguing with hallucinations or delusions; instead, provide calm reassurance. 6

Important Points to Remember

• Hyperactive delirium is a medical emergency, not a psychiatric problem or normal aging. 2
• It is often preventable with proper hospital care protocols. 1
• The hypoactive (quiet, withdrawn) form is more dangerous and more commonly missed than the hyperactive form. 1
• Delirium can happen even if you have never had memory problems before. 2
• Having dementia or memory problems before hospitalization significantly increases your risk of developing delirium. 2
• Report any sudden changes in mental status to your healthcare team immediately – early detection saves lives. 5