How do you communicate with people with delirium?

According to the American Delirium Society, over 7 million hospitalized patients experience delirium each year, yet effective communication remains a significant challenge for caregivers and family members. This guide explains how to communicate with people with delirium by using calming techniques, simplifying your language, and creating a supportive environment to reduce agitation and improve understanding.

Quick Summary

This guide covers best practices for communicating with someone experiencing delirium, including maintaining a calm demeanor, using simple and direct language, and modifying the environment to reduce confusion. It details how to provide reassurance and manage challenging situations, such as hallucinations or disorientation.

Key Points

• Stay Calm and Reassuring: Your tone and body language should be calm and non-threatening to avoid increasing patient agitation.

• Use Simple, Direct Language: Speak in short sentences and ask single, simple questions to aid comprehension.

• Don't Argue or Contradict: Avoid correcting a patient's distorted perceptions; instead, acknowledge their feelings and redirect the conversation gently.

• Orient the Patient Gently: Remind them of the time, place, and situation calmly, but don't force them to accept your reality.

• Provide Familiar Comforts: Use familiar objects like photos or a favorite blanket to create a more comfortable and predictable environment.

• Address Sensory Needs: Ensure the person has their eyeglasses and hearing aids, as sensory impairment can worsen confusion.

• Minimize Environmental Distractions: Reduce noise, glare, and clutter to prevent sensory overload that exacerbates delirium.

• Be Patient and Listen Actively: Give the person plenty of time to respond and listen empathetically to the feelings behind their words.

Understanding Delirium and Its Impact on Communication

Delirium is an acute state of confusion and altered awareness that can fluctuate throughout the day. It is not dementia, although it can occur in individuals with dementia and can be triggered by various medical conditions, medications, or post-surgical complications. The primary goal when communicating with someone experiencing delirium is to reduce their agitation and distress while maintaining their safety. Effective communication requires patience and a tailored approach, as the person's ability to process information is compromised.

Establish a Calm and Reassuring Presence

Your approach can significantly influence a person's state of mind. Maintaining a calm and steady demeanor is crucial to avoid adding to their confusion or fear.

• Sit at their level: Position yourself so you are at eye level with the person, especially if they are sitting or lying down. This makes the interaction less intimidating and more personal.
• Use a reassuring tone: Speak in a calm, soft, and respectful voice. Avoid yelling or speaking in a high-pitched voice, as this can be misinterpreted as anger or alarm.
• Maintain positive body language: Use open, non-threatening gestures. If appropriate and welcomed, a gentle touch on the hand or arm can provide a grounding reassurance. Always watch their reaction to ensure they are comfortable.
• Minimize distractions: Ensure the environment is calm by turning off the television, radio, or any other source of noise that could increase confusion.

Techniques for Clear and Simple Verbal Communication

Clarity is key when speaking to a person with delirium. Their ability to follow complex sentences or multiple commands is diminished.

• Use short, simple sentences: Keep your phrases brief and to the point. Instead of asking, "Do you want to get out of bed and sit in the chair for breakfast?" say, "Let's sit in the chair for breakfast".
• Ask one question at a time: Avoid overwhelming them with a series of questions. Yes-or-no questions are often the most effective. For example, "Are you thirsty?" is better than "What would you like to drink?"
• Repeat yourself calmly: If the person doesn't understand, repeat the same message using the same simple wording. Rephrasing or adding new information might cause further confusion.
• Allow plenty of time for a response: The person may need extra time to process your words and formulate a reply. Wait patiently for their answer without interrupting.

Orienting and Managing Challenging Symptoms

Reorientation is a gentle process of reminding the person of their current circumstances. This should be done carefully and without arguing.

• Remind them of the time and place: A simple reminder can help ground them. "It's Tuesday morning, and you are in the hospital recovering from surgery" is more helpful than a long explanation. Placing a large, easy-to-read clock and calendar within view can also assist.
• Validate feelings, not delusions: If they are experiencing hallucinations or delusions, do not argue with them. Instead, acknowledge their feelings. You might say, "I understand that must be scary," and then gently redirect their attention.
• Provide familiar items: Bringing in family photos, a favorite blanket, or other familiar objects from home can be very comforting.
• Engage with familiar faces: The presence of a known family member or friend can be very reassuring. Visitors should also follow these communication tips to provide a consistent and calming presence.

Essential Tools and Techniques Comparison

Technique	Description	Best For	When to Avoid
Reassurance	Providing verbal and non-verbal comfort to make the person feel safe.	Patients who are anxious or frightened by their confusion.	When the patient is highly agitated and touch might escalate the situation.
Simplifying Language	Using short, simple sentences and yes-or-no questions.	Patients with reduced attention spans or difficulty processing complex information.	Extended conversations or giving detailed instructions.
Reorientation	Gently reminding the person of the time, date, and location.	Patients who are disoriented but responsive to cues.	Arguing with the person over their distorted perceptions.
Redirection	Changing the subject when a patient is focused on an agitating or frightening topic.	Managing hallucinations or distressing delusions.	Using it too frequently, which can make the patient feel dismissed.
Environmental Modification	Reducing noise and visual clutter while providing familiar items.	Reducing sensory overload in a hospital or unfamiliar setting.	Removing all stimuli, which can cause further disorientation.

Conclusion

Communicating with someone experiencing delirium is a unique challenge that requires a compassionate, patient, and strategic approach. By focusing on maintaining a calm environment, simplifying your language, and reassuring the person, you can help manage their confusion and reduce distress. Remember that delirium is a medical condition, and the confused behavior is not intentional. For effective management, it is crucial to work closely with the healthcare team to address the underlying cause while employing these supportive communication strategies. Being present and providing a consistent, reassuring presence is one of the most powerful things a caregiver can do. You can find more resources and support for families of critically ill patients at ICUDelirium.org.

Frequently Asked Questions

What is the most important thing to remember when communicating with a delirious person?

The most important thing is to remain calm, reassuring, and patient. A person with delirium is easily frightened or confused, and your calm presence can provide significant comfort and help de-escalate agitation.

Should I argue with a delirious person about their hallucinations?

No, you should not argue with a delirious person about their hallucinations or delusions. Arguing will only increase their distress. Instead, acknowledge their feelings and then gently redirect the conversation to a more grounding topic.

How can I tell the difference between delirium and dementia when communicating?

Delirium is a sudden, fluctuating state of confusion, whereas dementia involves a gradual, progressive cognitive decline. Communication strategies may differ slightly, but the core principles of using simple language and a calm, reassuring approach apply to both.

Is it helpful to repeat information to someone with delirium?

Yes, repeating information is helpful, especially if you use the same simple wording. Their short-term memory and attention may be impaired, so repeating clear and concise information can reinforce the message without adding to their confusion.

What kind of questions should I ask a delirious person?

You should ask simple, single-topic questions that require a yes or no answer. Avoid open-ended questions that demand complex thought processes. You can also offer simple choices, such as "Would you like soup or a sandwich?".

How can I make the environment better for communication?

To make the environment better for communication, reduce noise and visual clutter by turning off the TV or radio. Use natural light during the day and keep it dim at night. Place familiar items and visual cues like a large clock or calendar nearby.

What if the delirious person doesn't recognize me?

It is common for a person with delirium to not recognize familiar faces. Don't be offended. Calmly introduce yourself and explain your relationship. "Hi, it's [Your Name], your [Relationship], and I'm here with you".