What is confusion?

Confusion is a term that refers to a decline in your cognitive ability. Your ability to think, learn and understand can be affected. Confusion is often associated with dementia, delirium and/or other medical conditions.

What causes confusion?

If confusion happens suddenly, it may be a sign of delirium. If confusion is chronic (long term) and comes on gradually, it may be caused by a medical condition.

Sudden confusion or delirium can be caused by:

• dehydration or malnutrition
• constipation or an inability to empty your bladder
• severe pain
• substances including sleeping pills, prescription medicines, heavy alcohol use or withdrawal from (stopping) alcohol, drugs or medicines
• medical conditions such as infections, stroke or seizures, concussion
• sleep deprivation
• low blood sugar levels

Medical conditions that can cause long-term confusion include:

• stroke
• chronic kidney disease
• dementia, including Alzheimer’s disease
• mental health conditions, such as depression or anxiety

If you suspect any of these conditions, it’s important to seek medical advice.

What are the symptoms of confusion?

If you are confused, you may be:

• agitated, anxious or fearful
• disoriented — unsure where you are or what day/time it is
• drowsy
• behaving differently to usual
• unable to think clearly
• uncertain what is happening around you

Confusion can suddenly develop and then pass. It can also develop slowly and become a long-term problem. Confusion can range from mild to severe.

How can I help someone with sudden confusion?

If you are with a confused person who needs help, here are some tips:

• Stay with them.
• If they have diabetes, check their blood sugar levels if possible. If their sugar levels are high, encourage them to take their medicines. Seek medical advice if symptoms worsen. If their levels are too low, give them a sugary snack or drink and wait 10 minutes. If there’s no improvement, call triple zero (000) and ask for an ambulance.
• Remind the person where they are — repeat this information throughout the conversation.
• Try to keep the person safe.

When should I call an ambulance?

Confusion can be a sign of a serious medical condition. Call triple zero (000) and ask for advice if you or someone you care for experience any of the following:

• sudden onset of confusion
• new or worse symptoms
• skin or lips are turning blue
• concern about the person’s health or safety

When should I see a doctor?

You should see a doctor if you:

• are worried about changes in memory and cognitive function
• suspect someone you care for is experiencing delirium
• suspect you or someone you care for shows signs of dementia

Can confusion be prevented?

To reduce the chance of becoming confused:

• maintain a healthy diet
• get enough sleep
• wear glasses and/or hearing aids as prescribed — ask your health professional if you need a check-up
• manage your blood sugar levels to prevent hypoglycaemia or hyperglycaemia if you have diabetes
• avoid drinking too much alcohol
• avoid drug use

How can I help someone with longer-term confusion?

If someone you know has longer-term confusion, there are ways you can help them.

Communication tips

• Do not assume they know who you or other people are. Always introduce yourself and others to them. This can be distressing for you, but will help them.
• Talk to them about current events, your thoughts and feelings.
• Orientate them using daily events. For example, instead of saying "He will be here at 2 o'clock", say "He will be here after lunch".
• Communicate in a warm and pleasant manner.
• Use non-verbal communication such as body language, tone and cues. These can be easier for the person to understand than verbal (spoken) communication. Non-verbal communication may also help reinforce your verbal messages. The person’s non-verbal communication may also reveal their thoughts and feelings. Examples of non-verbal communication include smiling or waving goodbye.

Tips for activities

• Help the person engage in activities and foster hobbies that promote health and wellbeing. Ideas include painting, playing cards, puzzles, quizzes and watching television.
• When planning activities consider the time of day the person is at their best. For example, sometimes it is best to walk in the morning, but if someone usually becomes restless later in the day, a late afternoon walk might be better.
• Help the person remain physically active by walking and doing gentle exercise together.
• Make sure the person gets enough rest and relaxation. Confusion can be worse at night if the person becomes overtired.

Personal care and diet

Make sure the person is treated with dignity and respect if they need help going to the toilet or with personal hygiene tasks.

Encourage them to eat healthy meals.

Tips for their environment

• Try to maintain a calm environment. Ensure there are not too many distractions such as loud noises.
• Keep lighting moderate; not too bright and not too dull. Night lights can help prevent falls or tripping over if the person is in unfamiliar surroundings.
• Place a clock and a calendar near the person so they know the date and time.
• If a person needs care away from their familiar surroundings, it can help to bring objects familiar to them. For example, a favourite blanket and photographs can be helpful.

Wandering

A person who is confused may be at risk of wandering. This is common in people living with dementia.

Someone who is wandering may become frightened. This makes it harder for them to cope.

They might be wandering because they:

• are looking for a place from their past
• believe they have a job to complete
• are bored
• are looking for a toilet

If you see someone wandering, here are some tips:

• Do not leave them alone, even if they refuse help and are distressed.
• Introduce yourself and offer support.
• Try calm them if needed and gain their trust — be respectful, caring and warm.
• Try to understand why they are wandering.
• Contact their family or friends.
• Check they are not injured, hungry, thirsty or need the toilet.
• Check if they have their usual glasses or hearing aids with them.

Take extra care to identify anyone at risk of wandering. Try to remove any triggers for wandering and creating distractions. For example, arrange for a chain for their glasses, so they can keep them around their neck when they’re not wearing them. Consider creating a safe place to walk around, such as a secure garden.

Resources and Support

• Call the National Dementia Helpline on 1800 100 500 (open 24 hours a day, 7 days a week) for information, emotional support and guidance.
• Visit Dementia Australia to learn about education sessions and group programs offered to carers, family members and friends of people living with dementia.
• Visit Diabetes Australia to learn more about hypoglycaemia, a life-threatening condition that is known to cause confusion.
• Learn more about epileptic seizures on the Epilepsy Action Australia website and how someone can feel confused for a short period of time before and after a seizure.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.