confused-elderly-womanWhile we know dementia is a common problem in the elderly, it’s important to be aware that various conditions can intensify its symptoms. Even individuals with no prior history can exhibit severe confusion when faced with UTIs, dehydration, or surgical anesthesia. Always take preventative measures where possible and be on the lookout for early signs of trouble.

Urinary Tract Infections

UTIs are one of the common causes of confusion in the elderly; in fact, this is often the first thing doctors test for when treating an older patient that presents with confusion. Symptoms include:

    • Confusion, unusual behavior, or sudden change in mental status
    • Sudden inability to perform tasks they can typically perform with ease
    • Urine that appears cloudy, red, bright pink, or brownish in color
    • Strong, persistent urge to urinate and/or passing frequent, small amounts of urine
    • Pain while urinating
    • Urine having a strong odor

Urinary tract infections should be treated with antibiotics immediately to avoid complications.

Steps that can be taken to reduce risk of UTI include drinking plenty of water, maintaining good hygiene, taking showers instead of baths, and avoiding use of feminine products such as powders and sprays in the genital area.


Another very common problem that can result in confusion, particularly in the extreme summer heat, is dehydration. Contributing factors include changes in the body’s water/sodium balance and decreasing thirst recognition, both deemed a normal part of the aging process. Medications can also have an impact, along with incontinence fears; some seniors tend to limit fluid intake to reduce incontinence issues, but that is a recipe for disaster.

Individuals with cognitive and mobility issues, whether living at home or in a care facility require extra help staying hydrated. Even those who are mostly independent often need reminders since they may not necessarily “feel” thirsty. Steer clear of diuretic beverages like those containing caffeine, devise a reminder system, and keep cold drinks within close reach; if your loved one spends the majority of his or her time upstairs and the kitchen is downstairs, consider a mini fridge for the second floor. Convenience is a major key to success.

Finally, if you’re having difficulty keeping them hydrated, get creative with presentation. Rather than continually serving plain water, try a variety of juices, infuse water with lemon or cucumber for added flavor, and include fruits and vegetables high in water content. At the top of the list are melons, strawberries, grapefruit, oranges, cucumbers, celery, zucchini, and tomatoes.

At the first sign of dehydration, offer a sports drink to help hydrate and boost electrolytes, and don’t hesitate to call the doctor for further assessment.


An article from Today’s Geriatric Medicine suggested that anywhere between 10 and 40% of older surgical patients experience postoperative delirium. This tends to be more prevalent after emergency or major surgeries, and the condition can last for several weeks. Individuals suffering from depression or in the early stages of dementia are also at higher risk.

For the best experience possible, it is suggested that the anesthesiologist be provided with as much medical history as possible, including a complete list of medications and supplements being taken, their dosage, and frequency. If your loved one has experienced postsurgical confusion in the past, be sure to communicate that ahead of time as it may have a bearing on the drugs used during surgery.

Barry Friedberg, MD, goes so far as to suggest older patients request use of a brain monitor during surgery to help gauge how much medication is needed. Without a monitor, Friedberg says most doctors will err on the side of too much rather than too little, fearing they won’t administer enough of the drugs.

In order to address special needs of elderly patients, some hospitals have geriatric anesthesiologists on staff. Be sure to ask about this option well in advance.

We’re interested in hearing your experiences with sudden confusion in elderly loved ones. Can you suggest warning signs or helpful tips for coping during what can be a frightening and stressful period?



  1. sharon henderson

    Thanks for sharing this artciel on Confusion I care for the elderly and this is very hard to get them to drink water

    • Ann Napoletan

      Sharon, thanks for reading and commenting. Hopefully some of the hydration tips will be helpful in your work. ~Ann

  2. Monique

    My mother was diagnosed with dementia in 2006. We however noticed the change in personality some 18 to 20 yrs ago. Mom only wants sweets and cola. She has a water dispenser, but she doesn’t use it much. Mom’s confusion and agitation really spike when you suggest something she isn’t interested in doing i.e., bathing, getting help with house work, considering assisted living etc.. Thank you for sharing your info. Creativity is key. 4 elder law attorneys have told us there has to be a “crisis” before anything can be done. Every day is a crisis for my sister and I.


    • Ann Napoletan

      Thanks for commenting, Monique…. it really is so difficult when they don’t want help or are in denial about needing it. Sending blessings to you and your sister. ~Ann

  3. Epoch Elder Care

    Great article dear author. I thought only dementia and alzheimer’s caused cnfusion and memory related issues among the elderlies!!

  4. Maureen

    Thanks. You nailed it. Our local hospital has a senior behavior unit and you were more helpful than they were. My mother in law hallucinated every time she went under anesthesia or had an infection. They diagnosed her with late stage alshiemers and dementia. Recommend nursing home or assisted living. Best thing was to get her home and back in her routines. Dementia would go away when infection cleared and she was properly hydrated.

  5. SonjA

    Hi it was great to find your site. My mother became suddenly confused not forgetful. It was quite different she was saying some really random and uncinnected things. After reading your website i called her doctor, he made her have some urine tests and we found it was an infection. After some stong antibiotics she is definately better but note cimepletely yet. I’m wondering if she may need another dose of antibiotics or there is damage from the infection. Has anyone experienced similar?

  6. Siham Ahmed Balla

    Thx for foundingthis page
    my 90 ys old father experienced chronic UTI given antibiotics
    Recently.given bacure infusion.
    multimedication also is given for long time ago.
    he is diabetic. He is experiencing body pain and insomnia
    being treated but not improving. Given pain killer, No pain inj. Vit B12 in
    I hope god help him

  7. Tina

    Hi, My mom is 86 years old. She has diabetes, heart trouble, high blood pressure. She goes to bed at 6pm and usually sleeps through till 530am but for the past week she has been waking up at 1am or 2am and thinking it is morning time so she starts calling people. Her nurse checked her urine for UTI’s and her urine is fine and her sugar count is fine. Any suggestions on what this could be???

    • Debra D Riddle

      My mother-in-law has dementia, but also has UTI’s…often. She has just completed a round of antibiotics last week. Yesterday she suddenly became more confused thinking day is night, and night is day. You can even show her it’s daytime, and or night time, and she is determined it’s the opposite. We don’t know which it is either…the dementia, or maybe the uti never was cured. She has slept most of the day today. She is eating some, but her appetite has surely decreased. We are trying to get her to drink, but I don’t feel that she’s drinking enough. She has had uti’s for over 3 years now, with not much relief. Doctor’s say that each time she gets and infection, she will continually get worse. Antibiotics aren’t working anymore. She will be 85 in August. If no improvement by tomorrow morning, we will be taking her back to the hospital. Last time they ran an I.V. antibiotic, and sent her home with antibiotics. Wishing you the best.

  8. Gillian

    My Dad went into hospital for bad gout in his toe.He was perfectly health other than the pain in his toe.After having the toe squeezed by the doctor which was extremely painful he had to have it done again and then the next day I came to hospital to find his so confused and like a dementia patent having helusenations! So terrible to see him like this.He was fine mentally when he came into hospital. I just don’t know what to do.

    • Lori

      That’s happening to my mom now at the hospital. Down hill in three days. I’m at the end of my rope with doctors testing and she getting worse. Did it get better? Any advice for me please?

  9. Gillian

    Hi it Gillian again. My Dad has bloodpoisen from the gout in his toe.Doc gave him 2 types of antibiotics now.He seems better but not right yet.At least we know it is not dimentia.

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    Hurrah! Finally I got a website from where I be capable of really
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  11. Tracey

    I have been caring for my grandparents for 4 years my nan has alzheimer’s and my grandad is now bed ridden, I am with them for six hours every day but it’s not enough,I have carers coming in also, from the minute I get home they are constantly on the phone, I now feel that they cannot cope being in there own home anymore,the plan is for them to move in with us, we are in final stages of buying a place big enough for us all but really need to put them in rest bite till then, neither of them want to do that it’s so hard and heartbreaking,just want what’s best for them x x

  12. Joanna

    My husband is 67, got hot mowing yesterday and drank very little. Today he was confused a little, didn’t know what day it was and a couple of other things. He seems better tonight.

  13. mary O'Driscoll

    95 year old dad suddenly became confused and inappropiate in 24 hours. was recently treated for pneumonia taking fluids urine putput fine. cxr negative. lost six pounds in one week, Have noticed him falling alot lately, was doing crossword puzzle in the last month, until macular regeneration got really bad, totally with it till yesterday saying his legs are to weak to walk refuses walker.Very stubborn.

  14. Deepika

    My mom who is above 50 and below 60 has lately been into a state of confusion and disorientation on most of the daily routine stuff like cooking, talking,taking care etc.
    When got her checked the doctors told us that, her brain shrinkage rate is higher than for most of us and gave some medication which lets her sleep fully in the night .But I am somehow not satisfied and not sure how should this be treated .
    Please suggest if anyone has a idea or a solution.
    She not even able to communicate properly .If tried to correct her she gets violent and angry .she is not even knowing what is happening to her.
    Kindly suggest.

  15. Judy

    94 dementia mom. What is happening. Staring of into space. Non responsive to calling her name. Than confused and doesn’t know where she is. Extremely fatigued. What happened here. Was it a tia?? Judy

    • Jan K

      Could be tia, but my dad developed what are called “absence seizures” late in his life. They pass in about a quarter to a half hour. Just something to look in to.

  16. Roxy

    Elderly often get uti infections. These can cause severe confusion. Try hydration and pure Oregano oil (natural antibiotic). 6 drops 3x daily for 2 weeks. Mix with other oils to lessen intensity. And of course ask a doctor first. And another tip do not use Miralax. It is poison.

    • Beverly

      There are times I have to use Miralax. I’ve had 2 UTIs with one hospitalization. I begged for help before they put me in the hospital only to fall on deaf ears. When I asked the dialysis nurse about the confusion it was then and only then that I learned there could be confusion associated with a UTI. I hope I never go through something like that again. Too, while in the hospital I was told I was lucky I didn’t have a stroke b/c of my BP being high.

  17. lesley

    My elderly Dad is in hospital right now and his personality has changed a lot from being a pleasant polite and very friendly person to being aggressive and not very friendly, this changed suddenly a week ago but while in hospital it has got worse, he has always had total respect for nurses and the good job they do and is always very nice with anyone he meets but now he throws his meds at them and i didn’t understand but reading this page has shown me a glimmer of possible hope, dads been through a lot and we knew recovery wasn’t going to be quick , he finish his radiotherapy early feb 2017 for a small throat cancer and soon after doctors found he had skin cancer on his ear which has been removed but he also has copd but this is under control, only a couple of years ago we lost our loving mum to Alzhiemers and dad had open heart surgery for heart failure, he has being through so much and is still missing mum so very much we all are, maybe this just goes proves dads a fighter, i truly hope so, can’t wait for him to be his self again, we can cope with dads illnesses but his personality change so sudden and all is heart breaking .

  18. lesley

    hi lesley again Ps, dad went into hospital they found he had chest and urine infections and constipated he wont eat and refuses to drink, i don’t under stand we are all worried dad is just giving up, but it’s not like him at all. thanks for letting me put my concerns on your page, cross my finger i get some tips of advice, could do with some badly x

  19. Jan K

    92 yo mom, who’s been failing for a few months, had a fall 6 weeks ago. Nothing broken but she’s been in bed since and sleeping a lot, with loss of muscle tone and poor appetite. Has started having confusion/paranoia on waking: can’t tell what time/day it is, swears no one has visited, and that she hasn’t been fed and is being “tortured.” She seems so sure and lucid while she’s saying these things that I know to be untrue! Not sure how to handle it, except to reassure her and try to distract her. Other times, she’s her sweet self. I suspect the long periods of sleeping leave her dehydrated. I’ve also seen UTI and other infections cause dementia-like symptoms in my dad before he died.

  20. Betsey

    My 85 year old mother is impatient right now. Sudden onset slurring and hesitation to connect words. Stops mid sentence and nearly falls asleep. She also is weak and cannot walk without assistance. Blood work is normal. Urine normal. Chest X-ray, CT and MRI mormal. So far there is no answer. She lives alone, still drives, makes her own appointments, etc. where do we look next?

    • Susan suffian

      Same thing is going on with my mom. No one knows what it is

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