In a recently released white paper, A Puzzle of Prevention: Recognizing the Role of Delirium in Preventing Rehospitalization, we examined delirium and its impact on rehospitalization and the realization that delirium, its symptoms and associated behavior greatly impact a care provider’s ability to address the medical issues that are affecting a resident or patient. 

Behaviors are kind of like figuring out a mystery sometimes. And what helped stop a behavior today does not mean it will necessarily work tomorrow. And what may have caused the behavior today may be far more indicative of a serious medical issue–as is the case with delirium—tomorrow. Learning the different causes of behavior changes for each resident is, many times, a never-ending cycle. Take the time to learn as much about each resident’s base line behaviors as possible, and what can possibly reduce or eliminate them and future changes in behavior. 

Why is it so hard to figure out what’s really happening?

In our previous blog, Depression, Dementia or Delirium: Which “D” is it?, we discussed the difference between the three. It’s critical to understand the difference as a means to understanding delirium’s impact on rehospitalization. 

Residents with dementia, delirium, or depression often lose the ability to use written or spoken words to communicate with their care givers.  These residents often rely on the use of non-verbal communication—most commonly in the form of behaviors.  Behaviors are most often a resident’s response, or actions and reactions, to stimuli or stressors in the environment. 

Pay close attention…the behaviors often give you clues as to the needs and emotions of the resident.

If your senior care staff effectively responds to resident’s actions and reactions, behaviors can be eliminated or minimized and the true, underlying medical emergency can be addressed.

In order to respond though, we have to understand why the behavior is occurring, or the meaning behind the behavior.

There are 3 types of behavior triggers: Internal, Environmental, and Caregiver.


Internal triggers are attributable to medical, social, or psychological causes. This type of trigger may mean that the resident is hungry, thirsty, or needs to use the bathroom. Or, as in the case of delirium, the resident is in pain or experiencing discomfort indicating an infection, constipation or other medical emergency. Unfortunately, internal triggers may also be the resident’s way of responding to depression, fear or anxiety.   

Environmental triggers come from the resident’s environment and can include changes in a resident’s routine, temperature, noise, lighting, unfamiliar surroundings or people. If a resident has too much or too little stimulation, the resident may get bored or experience sensory overload — both of which can result in behavior changes. Determining the difference between internal and environmental triggers can be key in understanding if you are dealing with a true medical emergency that’s being masked by delirium.

Caregiver triggers are associated with those who provide care or how that care is provided.  The caregiver may be providing too much or too little assistance, rushing the resident or using tense body language or speech, causing the resident to react negatively. Many times a resident will become combative or refuse personal care. 

To learn more about delirium, its behaviors and symptoms, download the white paper, or try Relias Learning’s free online course, Delirium, Dementia, and Depression.


Debi Damas, RN, is the senior care product manager at Relias Learning.