Hypoactive delirium: The critical need for collaboration between families and nurses in prevention, recognition and care

Delirium is a common and serious clinical condition that is associated with several adverse, and sometimes permanent outcomes. There are three primary types of delirium: hyperactive, hypoactive, and mixed. All three are characterised by a new acute onset of symptoms and changes in the person's normal behaviour (Hosker and Ward 2017). Hyperactive delirium involves restlessness, agitation, and heightened alertness. Individuals may be visibly agitated and distressed, displaying behaviours such as aggression, hallucinations, or incoherent speech. In contrast, hypoactive delirium is far more subtle and insidious. It presents as lethargy, drowsiness, and reduced responsiveness, with the person appearing disengaged and uninterested in their surroundings. While these symptoms may be a red flag for family and close friends who recognise the change in the patient's behaviour, hypoactive delirium can easily be mistaken for depression, fatigue or dementia, making it difficult to recognise and treat (Hosker and Ward 2017). Mixed delirium is a combination of both hyperactive and hypoactive symptoms, with the person alternating between periods of agitation and lethargy.