May is 89 years old and suffers from sudden confusion and dementia. While her story is sad and even tragic, it really demonstrates how the combination of extreme life stressors and the smaller brain can lead to equally extreme confusion. Until recently May was functioning on a very high level for someone her age. In fact she was providing some of the care for her aged husband.

Then due to the care she was providing she required back surgery. May suffered from excruciating pain prior to her surgery as well as following the procedure. This required her to be on narcotics, something that was certainly an assault to her brain. And one of those things known to cause elderly brains to shrink.

While recovering from her surgery, her husband of so many years died. Before May could adjust to the loss of her husband she received the news that her granddaughter had suddenly and tragically died as well. May then began to mentally spiral down, with the combination of grief, pain and narcotic medications, she could no longer cope.

May became delirious causing her to now be medicated with high powered psychotropic medications. She was physically restrained in a hospital bed, confused, agitated, delirious  and manic to the point of chewing on her fingers. Resulting in chewing off 1/3 rd of one of her fingers, in her extreme mental distress.

While the story of May demonstrates how extremes can result in sudden confusion, dementia and delirium. Her life tragedies could not have been for-seen nor avoided. The loss of her husband was expected but not the loss of a much loved granddaughter. Her back problems were possibly predictable depending on how much physical support she was providing for her ailing husband. However, that she would need back surgery and be on narcotics for the pain was not predictable.

But what we don’t know about May is how good of a job she had done taking  care of her brain during those 89 years. Our assumption is that she was doing a good job taking care of her health and her brain, due to the fact that at her advanced age she could participate in her husbands care.

So for May as well as many other elderly, sudden confusion and delirium are not all that unexpected or sudden when the tragedies of life arrive.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



Sudden confusion is related to the reduced capacity of the aging brain (size of the brain)and the many environmental abuses experienced. Reduced brain capacity happens over many years due to a variety of factors.

The size of the brain at birth is currently determined to be 23 billion cells. The brain grows not due to creating more cells but rather to creating connections between the cells.  Through learning the baby’s brain creates connections between cells that triple the size of the brain by the individual’s early 20’s. While those connections are important the connections noted to be the most important in increasing the size of the brain are those connections which in fact nourish the brain.

Babies and growing children who live an enriching environment will have significantly larger brain mass than those deprived of this environment. Then the goal becomes maintaining that brain capacity and constantly adding to the brain by creating new connections.

Researchers agree on these basic areas that will reduce brain size as you age:

  • medications
  • disease, especially chronic disease like heart disease
  • extended grief over personal loss
  • alcohol
  • not having a stimulating partner in life
  • bad living situations
  • inflexible personality style
  • sedentary lifestyle
  • high blood pressure – especially in middle age
  • lack of stimulation
  • low education level – lack of desire to learn – lack of curiosity
  • malnutrition
  • depression

When it comes to the brain it is certainly true that the more you have the more you can afford to lose. Knowing these areas that only do not support or maintain the brain but actually harm the brain, you can address these areas and reverse the brain shrinkage.Sudden confusion connected to reduced brain capacity then, though sudden is not really unexpected.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



Sudden confusion due to toxins may be expected and at times unexpected. Ralph was 86 when he decided that he was finished with dialysis. Ralph had end stage renal disease related to diabetes, and was on dialysis for over 10 years. Now Ralph decided that enough was enough and he wasn’t going any more. Ralph understood that this would be the end of his life. Without dialysis toxins would build up, and he would become very confused before those toxins would end his life.

Mike arrived at the nursing home due to extreme sudden confusion, related to alcohol abuse. A very long history of alcohol use and abuse. When Mike arrived he had been begging for money from strangers on the street in order to go to a hotel, because he was sure someone had put cameras all over his house. He thought he could no longer live in his home because there was a bomb, and he was being watched.

Many elderly suffer from sudden confusion due to medication mistakes. When the elder is managing their own medications and do not have a good reliable system in place, mistakes often happen. The elder then is admitted to a hospital where lab tests are run, and the medication is identified. However it might then take some time for that sudden confusion to resolve.

People as they age begin having more and more difficulty with toxins. This is due to the lifetime of environmental toxins their brain has been subjected to. Just one example is the history of using leaded gas, and the toxic effects due to use of that gas. Research studies have shown that older Americans have much higher levels of lead than younger people who were not exposed.

As the elder ages, they have a reduced brain capacity due the shrinkage of the brain. The combination of reduced brain capacity and that lifetime of exposure to many environmental toxins, put them at higher risk for sudden confusion. The elderly brain just has less to work with and at the same time more to deal with. (see also delirium)

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing