Confusion in Older Adults

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Confusion in Older Adults

Being in a state of confusion means feeling disorientated, struggling to remember, make decisions, remember things or to think clearly. It can also lead to an added risk of a fall. Confusion could be a medical emergency.  If you’re not sure, it is important to call 9-1-1.  Many individuals with no prior history of cognitive problems or dementia can experience confusion. Signs and symptoms of confusion usually begin over a few hours or a few days. The symptoms may fluctuate and there may be periods of no symptoms. If your loved one is presenting with behaviours or memory or cognitive changes, step one is to do your own assessment. A simple assessment of confusion is to ask the person their name, age, where they think they are and today’s date. Prior to seeking advice from your medical doctor, the more accurate information the better. Take note of mood, appetite, energy level, sleep patterns, elimination for bowel and bladder; medication use, substance or alcohol use and normal  behaviours and activity levels. Your input about the person’s symptoms, as well as his or her typical thinking and abilities, will be important for finding the cause, diagnosis and treatment. Buy a notebook and make notes! Again, if you’re not sure, seek medical attention.


  • lack of oxygen in the blood (hypoxia)- the cause could be from anything ranging from an infection, a lung or heart condition or underlying medical condition
  • an infection anywhere in the body
  • a low blood sugar level
  • diabetes
  • medication misuse
  • alcohol or substance use/abuse
  • stress or anxiety or depression

Here’s a more in depth review of 3 frequent causes of confusion:


UTIs are often the first thing doctors will test for/rule out through a simple urine test.

Symptoms may include:

  • behavioural changes, confusion, sudden change in mental status
  • agitation, impatient and angry reactions
  • fatigue
  • sudden inability to perform activities of daily living
  • urine that may have a strong odour
  • may have a different colour than usual urine that appears cloudy, pinkish or brownish in colour
  • strong persistent urge to urinate
  • complaint of burning or pain while urinating
  • increased signs of confusion, agitation or withdrawal
  • no symptoms


Multiple prescription medications and/ or over the counter medications are often required to manage health conditions as people age. When was the last time  prescribed medications and over the counter medications were reviewed by the doctor and or pharmacist? Medication reviews are free with your pharmacist. Call to book an appointment.

Older adults may suffer serious consequences from improper drug or medication use. Aging brains and other physiological changes puts a person at greater risk for harmful effects of the drugs in the body and can affect strength and balance, putting a person at risk of falling. Older adults are particularly vulnerable to adverse drug reactions, side effects and drug interactions. These medications can include vitamins, aspirin and tylenol misuse.

Many older adults take medication to treat health conditions including pain and heart disease.  Some people take medications incorrectly without knowing it. They may forget their medicine or take it too often or take the wrong dose. As people age, trouble with vision or memory can make it hard to use medications correctly. Intentional misuse occurs when a person knowingly take the medication or substance the wrong way, or combines with alcohol or other drugs. How much alcohol is your parent or loved one drinking on a daily basis? Have you ever discussed or checked?


Dehydration is a term used to describe excessive water loss or inadequate water intake which disrupts the body’s normal functions.

Signs of dehydration in older adults: 

  • confusion
  • loss of balance and difficulty walking
  • dizziness or headachesabout1
  • dry mouth or lips
  • rapid heart rate
  • rapid,weak pulse
  • low blood pressure
  • yellow or dark coloured urine
  • decreased or no urine output
  • constipation
  • cramping in limbs
  • headaches
  • weakness
  • sleepiness/irritability

Causes of Dehydration:

  • diarhhea
  • excessive sweating due to heat, humidity or fever
  • loss of blood
  • diseases such as diabetes
  • medications such as diuretics
  • illness
  • decreased kidney function

Water is what sustains life and contributes to changes in the body’s water/sodium balance. The normal level of hydration varies from person to person. A lot of people get their water from foods such as fruits, soups and vegetables. Caffeinated beverages are dehydrating. Teas and coffee amounts should be observed and monitored. 8 glasses of water has been the recommended but depends on a person’s body weight and there’s no one size fits all remedy.

It is so important to be informed and to not ignore a loved one who is presenting with signs and symptoms of confusion as discussed. Gold Cross Home Care is an agency that supports and cares for individuals of all ages living at home; in long term care facilities, hospitals and retirement homes in Hamilton, Burlington, Dundas, Ancaster, and Stoney Creek. The owner is Joanne De Rubeis an RN of 30 years and graduate of Mc Master University Bachelor of Science in Nursing who takes great pride in helping people with their health care needs and how to navigate the health care system. She is always available to discuss your loved ones needs.

Joanne De Rubeis RN BScN OCT Owner, Gold Cross Home Care Inc.

Joanne De Rubeis
Gold Cross Home Care Inc.




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