A person who has trouble thinking and acting appropriately or has disturbed thoughts is said to be confused. A person with a progressive illness may become confused due to the illness, infection, a side effect of medications, decreased fluids, or during the final days. Tell your home care nurse if you notice the start of confusion and ask if anything can be tried to help.

What you need to know

At some point, confusion often goes hand-in-hand with a progressive physical illness. Understanding how a confused person might act may help you to feel less anxious when you see unfamiliar behaviours.

• Confusion can start very slowly.
• It can appear as poor concentration, loss of memory and of interest.
• Making decisions may be difficult because of poor concentration.
• The person may describe a sense of unreality or the feeling of “losing my my mind.”
• Feelings may fluctuate between denial and acceptance of the situation.
• A confused person may become restless and move about in a random fashion. There may appear to be pain.
• The person may hallucinate (see or hear things that are not real), particularly at night.
• Strange thoughts may bother the person.
• Fear and anger may appear for no obvious reason.
• Movements may become slow or agitated.
• Confusion can become so severe that the person cannot make proper decisions. In this case, having an advanced care plan and substitute decision maker in place will help in making health decisions and taking legal responsibility for affairs.

How you can offer comfort and care

Since harm can come easily to a confused person, close supervision and guidance are needed.

• When appropriate, quietly remind the person who you are whenever it seems necessary.
• If it does not cause agitation, gently touch the person during conversations to remind that you are there.
• Stand face to face and stay within a respectful space of the person when talking.
• Turn off radio and TV, and do not play them together or loudly.
• Talk slowly and quietly, using short statements.
• Aim to be a quiet presence that supports the confused person. Be aware that trying to correct the confusion or hallucinations may cause more agitation.
• Consider keeping a calendar and clock in view. When asked, you can try to gently remind them of what day and time it is.
• Keep the room well-lit, unless light is disturbing.
• Do not give medications or any care without explaining what you are doing.
• Do not leave the person alone.
• Use preventative measures to reduce the chance of the person falling out of a chair or bed.