Merck Manual

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Confusion and Mental Decline Due to Hospitalization


Michael Joseph Pistoria

, MEng, DO, Lehigh Valley Hospital - Coordinated Health

Reviewed/Revised Oct 2023

Being ill, particularly when it involves taking medications for pain or anxiety, can make anyone confused. The hospital environment adds to the problem. There, people give up their personal effects and clothing—marks of their identity—for a hospital gown. They are in a strange place without familiar landmarks and usual routines. Often, hospitals provide little stimulation (such as sights, sounds, and interaction with other people). People may be alone or with an uncommunicative roommate in a room that has blank white walls and bland, institutionalized furnishings. For most of the time, there may be no one to talk with.

Hospital procedures and schedules can be disorienting. For example, people may be awakened frequently during the night, depriving them of needed sleep. They may be unable to get their bearings in an unfamiliar, dimly lit room. The many tests and the complicated equipment may be overwhelming.

Intensive care units Types of units (ICUs) can be even more confusing. People in ICUs are alone, sometimes with no windows or clocks to help them orient themselves. The beeping of electronic monitors, constant bright light, and frequent interruptions to take blood, to change intravenous (IV) tubes, or to give medications may interfere with sleeping. People who are tired are more easily confused and disoriented. Sometimes confusion is so severe that people develop a type of delirium Causes Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function. It is characterized by an inability to pay attention, disorientation, an inability to think clearly... read more called ICU psychosis.

If people become unusually confused while staying in a hospital, family members should tell staff members so they do not assume that it is the person's normal behavior. Delirium can usually be cured if its cause (a disorder, medication, or stressful situation) is corrected.

In certain situations, people can become so confused that they do not understand why they are in the hospital. They can become agitated and try to get out of bed, pull out intravenous (IV) lines or other tubes, or do other things that may harm themselves or others. They may misinterpret another person's action as a threat and respond by becoming physically threatening themselves. In such cases, the presence of a friend or family member may help calm them. Sometimes a hospital staff member stays with people 24 hours a day to prevent them from doing anything dangerous. Rarely, physical restraints are applied or small doses of an antipsychotic medication are given until people are no longer confused.

Prevention of Confusion and Mental Decline in the Hospital

Staff and family members can help keep people oriented by doing the following:

  • Making sure that the lighting in the room is adequate

  • Providing a calendar or clock that is easy to see

  • Encouraging people to get out of bed, walk regularly, and do as many usual daily activities as possible

  • Talking with people about what is going on outside the hospital to keep their mind active

  • Explaining tests and treatments to help people understand what is happening and why

  • Making sure people who wear glasses or a hearing aid have and wear these items

  • Making sure that people consume enough fluids and food (dehydration can cause delirium)

  • Letting people sleep without interruptions as much as possible during the night

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