22/11/2025
We are delighted to share this article from Gina Awad someone Peninsula Care Homes has worked with for over a decade.
"I have worked alongside families and communities affected by dementia for a number of years. In 2014, I founded the Exeter Dementia Action Alliance, which has been a significant part of my journey. I now continue this work as a dementia consultant, advocate and author, passionate about sharing practical, accessible information that can help families, carers and care teams alike. In addition, I host a voluntary radio show called ‘Living Better with Dementia’ on Phonic FM 106.8, which airs on the fifth Saturday of each month. I’ve been doing this for the last nine years, and it’s been a wonderful way to connect with people and share information in an engaging, accessible way.
I’m delighted to share this blog, which draws on a recent talk I attended by an Admiral Nurse from Dementia UK. I hope it helps families and carers better understand and respond to delirium, a sudden and often reversible change in a person’s cognitive function that is particularly common in people living with dementia. Recognising delirium early can make all the difference, especially when there are changes in routine, environment and activity which can increase the risk.
Delirium - What We All Need to Understand
I’ve seen firsthand how easily sudden changes in a person’s responses or awareness can be misunderstood.
Delirium isn’t something we hear much about, yet it’s a serious and often reversible condition that can develop quickly, over hours or days. It can affect anyone, but it’s up to ten times more likely in people living with dementia.
What struck me most was how easily it can be missed. A sudden change, someone seeming quieter, agitated, confused, or just “not themselves” might be seen as part of dementia’s progression, when in fact it could be delirium. Recognising it early can make all the difference.
The Two Types of Delirium
• Hyperactive delirium - the person may seem restless, agitated, fearful, or even aggressive.
• Hypoactive delirium - this quieter form can look like sleepiness, withdrawal, or a loss of interest in what’s happening around them.
Some people experience a mix of both, moving between restlessness and drowsiness.
Recognising the Signs
Delirium can vary widely, but common signs include:
• Sudden confusion or disorientation
• Changes in attention or awareness
• Agitation or unusual quietness
• Hallucinations or seeing things that aren’t there
• Disturbed sleep or reversed sleep patterns
• Rapid mood changes
• Unsteady walking or increased falls
These changes often appear suddenly that’s what sets delirium apart from dementia, which tends to progress gradually.
The “PINCH ME” Approach
A simple and widely used way to check for possible causes of delirium is the P.I.N.C.H.M.E approach. It’s used by professionals across healthcare and social care settings and it’s something families can learn from too:
• P – Pain
• I – Infection (urinary or chest infections are common triggers)
• N – Nutrition
• C – Constipation
• H – Hydration
• M – Medication (side effects, new prescriptions, or missed doses)
• E – Environment (unfamiliar surroundings, noise, lighting, or disrupted routine)
When something feels “off,” working through this list can help identify what’s going on. For instance, if infection is suspected, it’s vital to get a urine sample or medical review quickly.
Sometimes the cause is dehydration, pain or a new medication but without recognising delirium, it’s easy to miss.
Why Awareness and Familiarity Matter
Delirium can often be treated successfully once the cause is found, but if left unchecked, it can have lasting effects on both health and wellbeing.
Awareness brings calm and confidence. When carers, friends or hospital staff recognise delirium and act swiftly, outcomes are so much better, not just medically, but emotionally too.
And that’s where familiar faces play such a vital role. When someone is disoriented or frightened, the gentle reassurance of a loved one can be grounding and soothing in ways that medicine alone can’t achieve.
Initiatives like John’s Campaign (https://www.johnscampaign.org.uk/) beautifully champion this supporting families to stay with loved ones in hospital at a time them all, recognising that connection is not a luxury but a lifeline. Having someone familiar close by can help reduce distress, aid recovery and restore a sense of safety.
Delirium reminds us that sudden change always has a reason. With timely care and the presence of people who truly know the person their clarity and sense of self can often return.
With the festive season approaching, this feels like a particularly poignant time to share this blog. Changes in routine, busyness and unfamiliar surroundings over the holidays can increase the risk of delirium, so being aware, prepared and present can make all the difference."
Gina Awad BEM
Dementia Consultant, Advocate & Author
