The C is for chronic, happening over and over. And the T is for traumatic, meaning this isn’t just a little bump on the head, it is a repeated injury.  But that E is a problem in healthcare. E is for enchephalopathy.  Since the movie Concussion came out more people are aware of the high cost of getting repeatedly hit in the head. This could be for any reason, where a person sustains head injury. From having epilepsy, and during seizures, hitting your head on hard surfaces, to boxing head injuries, sports injuries and now to the current focus of playing football.

The reason it is difficult to differentiate between delirium and enchephalopathy is because even the medical community seems to use these terms interchangeably. The common use of delirium is an altered mental state, well so is it for enchephalopathy. It is only when a person needs that diagnosis for reasons of medical insurance or healthcare intervention that things get more specific.

Much easier to see than a physical injury, is when delirium relates to the abuse of alcohol. The person who is drunk may be unsteady on their feet, having balance problems to the point of walking into things and even falling down. Their thinking will be foggy, unable to communicate their thoughts clearly. In fact their speech can be slurred as well. The next day they may have no memory of the events of the day before, while they were drunk.

If that person continues to abuse alcohol over a long period of time the damage to the brain would no longer be considered delirium. Those changes are no longer happening quickly, and no longer reverse, now they are a permanent change in the person’s brain.

And so, also for that football player who sustains a significant hit to the head, they might have a mild concussion. They might be unsteady on their feet and be confused for awhile. But after repeated abuse, just as with the alcoholic, the changes over the years may be subtle and develop slowly. But the end result could be the same. Poor judgement, poor coordination, gross distraction, tremors or muscle twitching and dementia.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology



Delirium is a sudden change in a person’s mental abilities and is common in the elderly with acute medical illness. The elder with dementia will have a greater risk of developing delirium when ill, than the elder without dementia.

Delirium can be caused by infections, pain, sleep deprivation, dehydration, metabolic or electrolyte disturbances, constipation, and many times medications especially psychoactive medications. The evaluation process can be extensive because of the large number of possible causes.

Finding out the cause of the delirium is the first priority. Once the medical cause is brought under control it will usually still take some time for the delirium to resolve, even months.  During the time of recovery it is important to:

  • Provide optimal nutrition and hydration
  • Ensure the elder’s safety
  • Encourage a routine sleep – wake cycle
  • Provide a calm environment
  • Make sure that eye glasses are clean, hearing aids are working and dentures are in.
  • Provide good lighting, even during the day keep lights on
  • Simplify – reduce clutter, noise, few visitors


In his later years my father would become delirious every time he was hospitalized. I would position myself in front of him, smile and reassure him all was well. When staff would come into the room I would introduce them to Dad and tell him why they were there and what they were doing. I avoided side conversations with staff or visitors and only concentrated on Dad. When he recovered he would remember the bugs running up and down the walls, but he would also remember me just sitting there smiling.


Virginia Garberding RN

Certified in Gerontology and Restorative Nursing





THE DEFINITION OF DELIRIUM: A condition of acute and sudden onset of impairment of attention, memory, orientation, language usage, consciousness, perception, behavior and/or emotions that may fluctuate. This is a condition that is directly related to a medical cause and is not due to dementia. It is often called “acute confusion.”

This is not the confusion associated with a terminal condition that occurs in the days before dying. This “terminal delirium” is irreversible and often calls for the use of anti-psychotic medications for the comfort of the patient. Sudden onset delirium is reversible and requires testing for possible cause.

Delirium caused by a medical condition is often confused with dementia and requires a clear history from the family. The areas to report to your healthcare provider are;

  • Is the person more confused today than yesterday? Was this a sudden change in the person’s mental status? If the person is more confused and the increase came on suddenly, you need to consider delirium.
  • Is the person more easily distracted, unable to focus his attention or unable to follow what is being said, than previously? A person with mild cognitive impairment can usually say the days of the week backwards or recite the months of the year backwards. The person with delirium is too distracted to focus on a task like this.
  • Is the person’s thinking disorganized or incoherent? Is the person rambling, has an illogical flow of ideas, or engages in irrelevant conversation? Ask the person a few questions to assess their train of thought:
  1. Will a stone float on water?
  2. Are there fish in the sea?
  3. Does one pound weigh more than two pounds?
  4. Can you use a hammer to pound a nail?

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing