Changes, confusion and urgent concerns

A sudden change in confusion, behaviour, mobility, continence, eating or drinking may signal illness, medication problems, distress or a safeguarding risk. Do not assume every change is due to dementia.

Listen for change from usual

A carer saying "this is not like them" can be a key warning. New confusion, drowsiness, fever, falls, pain, not drinking, reduced urine output or sudden agitation may need urgent clinical review.

Reception staff should record the caller's exact words and follow the local urgent route when symptoms are concerning. Avoid assuring callers that confusion is expected because the patient has dementia.

Escalate when

• Confusion is sudden or much worse than usual.
• There are falls, injury, fever, dehydration or pain.
• The patient is missing, lost or unsafe at home.
• A carer cannot keep the person safe.

Known dementia should never hide a new physical, mental health or safeguarding concern.

If staff are unsure, they should record the facts and seek clinical advice rather than making informal arrangements that could breach confidentiality or leave the patient without support.

Sudden confusion may be described in everyday terms, such as "not right today" or "not drinking". These phrases should be recorded precisely, not diluted into vague notes, because they may indicate a clinically important change.

New confusion, falls, drowsiness or reduced drinking should prompt clinical review and must not be assumed to be usual dementia without assessment.

Clinical background