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First, do serum electrolytes, urea creat, cbc, crp, malaria ict (if at risk) Rule out dyselectrolytemia, sepsis or any infection. If all reports are normal it's most likely post hospital delirium which is common at this age. In that case give melatonin 6 mg at night. And low dose olanzapine(5mg later 10mg if not improving ) at night bed time . Give these for atleast 5-7 days. And most importantly talk with him, reassure, reorient him the time , place. Expose to sunlight, allow a calm environment at night. Allow meeting with family members. And yes, if the symptoms don't improve , better to do a CT brain to rule out any cerebral cause.

Need to investigate more about electrolyte profile so that we rule out the metabolic impairment and consult for further diagnosis and management

Please consult with your Doctor who did the hip surgery. It is only 6 days since he got operated.

This situation requires urgent medical attention. Please do not attempt to sedate him with over-the-counter sleep aids at home. ​Your grandfather is likely experiencing Post-Operative Delirium. This is a common but serious condition in elderly patients following major surgery like a hip fracture repair. It is a state of acute confusion caused by the body's reaction to surgery, anesthesia, pain, or potential electrolyte imbalances. ​1. Immediate Steps ​In-Person Evaluation: He needs to be seen by a physician immediately. If he is at home, he should be taken back to the hospital or seen by his primary consultant. ​Safety First: Since he is restless and has had a recent hip surgery, ensure he is supervised at all times to prevent a fall, which could dislodge the surgical repair. ​Orientation: Keep the room well-lit during the day, keep his glasses or hearing aids on (if he uses them), and have a familiar family member talk to him calmly to help "re-orient" him to his surroundings. ​2. Why "Sleep Medicine" is Complicated Here ​Avil (Pheniramine): Your orthopedic surgeon was correct to stop this. Antihistamines can worsen delirium and hallucinations in the elderly. ​Seizure Risk: Since he is on Levetiracetam (Levera), any new sedative must be checked for interactions to ensure his seizure threshold isn't lowered. ​Pain Management: Sometimes, delirium is triggered by uncontrolled pain. The doctors need to review if his current painkillers are sufficient or if they are contributing to the confusion (certain high-strength painkillers can cause hallucinations). ​3. Necessary Investigations The medical team will likely need to check: ​Urine and Blood Culture: To rule out a hidden infection (like a UTI), which is the #1 cause of delirium in seniors. ​Electrolytes: To check for sodium or potassium imbalances. ​Oxygen Levels: To ensure his brain is receiving adequate oxygen post-surgery. ​Summary Advice: Delirium is a medical emergency. Please contact his treating physician or a General Physician immediately to discuss starting low-dose, safe antipsychotic medications (like Quetiapine or Haloperidol) specifically used to manage delirium, rather than standard sleep tablets.

Looks like post surgery delirium confusion, no sleep, hallucinations. This needs urgent doctor review please do not delay or give sleep medicines on your own.

Could be delirium .. plz do consult a GP asap.

​"I am sorry to hear about your grandfather's condition. Based on the symptoms you've described—acute sleep loss, confusion, irrelevant talking, and hallucinations following surgery—he is likely experiencing Post-Operative Delirium. This is a common and serious condition in elderly patients, especially those with a history of stroke. The 'sundowning' effect (worsening at night) is very characteristic. While Avil was being used previously, it should definitely be avoided now as it can further cloud his mental state and increase the risk of falls."

The symptoms described—acute onset of confusion, hallucinations, sleep-wake cycle reversal, and restlessness in a 78-year-old post-hip surgery patient—are classic indicators of Postoperative Delirium (POD). This is a medical emergency in the elderly and requires a systematic approach to identify the underlying "trigger." 1. Immediate Diagnostic Workup Delirium is often the first sign of an underlying physical issue. I recommend the following: Rule out Infection: Urinalysis and culture (UTI), and a chest X-ray (pneumonia). Metabolic Screening: Check electrolytes (specifically Sodium), renal function, and blood glucose levels. Oxygenation: Check pulse oximetry to rule out hypoxia or silent pulmonary embolism. Review Levera: Levetiracetam can occasionally cause neuropsychiatric side effects; this should be reviewed by his neurologist or attending physician. 2. Medication Management Antihistamines (Avil): The surgeon was correct to stop this. Anticholinergic drugs like pheniramine are major triggers for delirium and increase fall risks in the elderly. Sedation: If the patient is highly agitated or a risk to himself, low-dose atypical antipsychotics (e.g., Quetiapine) are generally preferred over benzodiazepines, which can cause paradoxical agitation in this age group. 3. Non-Pharmacological Interventions Reorientation: Ensure the patient has his glasses/hearing aids. Use a clock and calendar in the room. Sleep-Wake Cycle: Keep the room bright and engage him during the day; keep it dark and quiet at night. Mobility: Encourage supervised sitting or walking as per orthopedic clearance to help "ground" the patient.

It may be due to post operative stress, anxiety,  pain, senile dementia,  electrolytes imbalance, any one or more of these causes. Please check with a physician offline.

Consult superspecialist immediately. U can try  clonazepam 1.0 mg +quitipine50  one at 9.0 pm

Consult general physician immediately

Insomnia

This looks like acute postoperative confusion, most consistent with Delirium — very common after hip fracture surgery in elderly patients. On Levera → can sometimes increase irritability/agitation For elderly delirium, avoid antihistaminics like Avil — they worsen confusion. For sleep and agitation, low-dose quetiapine 12.5–25 mg at night (or low-dose haloperidol if severe) may be considered under supervision. Non-pharmacological measures like reorientation, day–night cycle maintenance, and hydration are equally important. Urgent in-person review advised."

Psychiatrist

Kindly do connect and consult

Keep him hydrated

Do consult

The cause for the altered sensorium of your father to be find out and to be treated accordingly, he need In-patient treatment at present.

It may be due to stress post operative Or Senile causes for Insomnia . Melatonin 5 is one without hallucination. Supplement him with Vit D

Need a few more details please consult for further evaluation and treatment