What is confusion?

Confusion is a term that refers to a decline in cognitive ability, that is, our ability to think, learn and understand. A decline in cognitive ability is often associated with dementia.

Symptoms of confusion include problems with short-term memory, difficulty carrying out tasks, poor attention span, unclear speech and difficulty in following a conversation.

Sometimes confusion can be temporary and will pass. Sometimes confusion is long term and is due to a permanent condition.

When should I call an ambulance?

Confusion can be the 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
• other signs of illness, such as fever
• skin or lips are turning blue

If you need to help a confused person:

• stay with them
• if they have diabetes, check their blood sugar if you can. If it's too high, call triple zero (000). If it's too low, give them a sugary snack or drink and wait for 10 minutes. If there's no improvement, call triple zero (000)
• remind the person where they are — repeat this information throughout the conversation
• try to keep the person safe from harm

What are the symptoms of confusion?

A person who is confused may be:

• unable to think clearly
• uncertain what is happening around them
• unsure what day or what time it is

Confusion may come on quickly or develop over time (more so in older people) and can range from mild to severe. It may cause:

• frustration
• aggression
• unusual behaviour or mood swings
• anxiety

What causes confusion?

Confusion, or being confused, is often associated with growing older.

However, this is not always the case. Sudden confusion, also known as delirium, can be caused by a number of other factors:

• drinking too much alcohol
• side effects of some medicines
• using some recreational (illegal) drugs
• taking too much medicine or drugs (an overdose)
• lack of oxygen to the brain (such as from acute asthma, heart or lung problems)
• head injury or concussion
• poisoning
• lack of sleep

Delirium can also be a caused by medical conditions, such as:

• some mental health conditions
• an infection in the body, especially among older people
• a stroke or a mini-stroke (TIA)
• low blood sugar
• shock

Some medical conditions can cause long-term confusion. These include a stroke, epilepsy or seizures, poor kidney function, Alzheimer’s disease or other forms of dementia.

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

Can confusion be prevented?

There are a number of things you can do to help prevent confusion:

• Don’t drink too much alcohol.
• Avoid recreational (illegal) drugs.
• Eat a healthy, balanced diet with plenty of fresh fruit and vegetables to prevent vitamin or mineral deficiencies.
• If you have diabetes keep an eye on your blood sugar levels to prevent hypoglycaemia or hyperglycaemia occurring.
• Rest and get enough sleep.
• Take any prescription medicines as prescribed by doctor.

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

• If the person forgets who you are, always introduce yourself to them, no matter how well or how long you have known them. This can be distressing for you as a carer but will help the person you are looking after.
• Talk to the person about current events.
• Explain who other people are: "This is your son, Jack".
• Help to orientate the person using daily events. For example, instead of saying "He will be here at 2 o'clock", say "He will be here after lunch".

Tips for activites

Try to encourage peaceful and quiet activities that stimulate the mind, such as painting, playing cards or watching television and completing puzzles or quizzes.

Encourage the person to remain physically active by walking and doing gentle exercise if possible, but also make sure they get plenty of rest and relaxation. Confusion can be worse at night if the person is overtired.

Personal care and diet

Make sure the person is treated with dignity and respect if they need additional help with going to the toilet or with personal hygiene tasks such as washing or getting dressed.

You can also help to ensure the person is eating nutritious and healthy meals, avoiding too much sugar, salt and processed foods.

Tips for their environment

• Try to have a calm and peaceful environment where the person is not constantly distracted by noise or too much activity going on around them.
• The temperature of the room should ideally be around 21-23°C.
• Keep lighting at a moderate level, not too bright and not too dull. Night time lighting may be needed to prevent falls or trips if the person is in unfamiliar surroundings.
• Place a clock and a calendar near the person so they are reminded of the date and time.
• If a person needs care away from their home and familiar surroundings, it can help to have objects that are familiar to them, for example a favourite blanket and photographs.

Wandering

A person who is confused may be at risk from wandering — for example looking for a toilet or trying to find their way home.

Take extra care to ensure that people who have memory problems, particularly older people, are monitored to reduce the risk of wandering. This may include moving toilet facilities closer to the person or creating distractions to avoid boredom.

If you encounter someone who is wandering, be aware that they may be frightened, unable to communicate properly, and may have health problems that affect their understanding and their movement.

It is important to calm them down and show them they can trust you. Introduce yourself, offer help and talk to them respectfully. Try to understand their reason for wandering and see if you can contact family members or friends. Check they aren’t injured, hungry, thirsty or need the toilet.