Looking for causes: pain, infection, constipation, dehydration and medicines

Delirium improves when the underlying cause or combination of causes is identified and treated. Care staff do not make diagnoses, but they provide vital observations: recent food and fluid intake, bowel movements, signs of pain, changes in medicines, sleep pattern and how quickly the altered mental state developed.

NICE advises addressing infection, dehydration, constipation, immobility, pain, medicines, nutrition and sensory impairment when preventing and treating delirium. Northern Ireland HSC guidance highlights pain, infections, poor intake, constipation, dehydration and medicine side effects as practical triggers to consider.

Useful observations to collect before escalation

• Pain clues: guarding, grimacing, agitation on movement or a new refusal of care.
• Intake clues: drinking much less, leaving meals, dry mouth or recent vomiting or diarrhoea.
• Constipation clues: abdominal discomfort, no recent bowel movement, straining or repeated toilet trips.
• Infection clues: fever, cough, change in urine pattern, new incontinence, shivering or feeling hot or clammy.
• Medicine clues: new medicines, recent dose changes, missed doses or unusual drowsiness after medication.
• Mobility clues: new weakness, slower walking, needing more help or reduced movement in chair or bed.

Frontline care staff do not have to diagnose delirium to be clinically useful. Clear observation of likely triggers is part of safer care.