BMJ  2007;334:842-846 (21 April), doi:10.1136/bmj.39169.706574.AD

Clinical Review

Clinical review

Delirium in older people

¹ Academic Unit of Elderly Care and Rehabilitation, University of Leeds and Bradford Teaching Hospitals NHS Foundation Trust , ² Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, and Aging Brain Center, Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA

The first 150 words of the full text of this article appear below.

Few ill health situations are more degrading to people of any age than loss of reasoning, faculties, and personhood. These are the unpleasant consequences of delirium—a common condition affecting ill older people, particularly those with some degree of dementia. It is characterised by recent onset of fluctuating inattention and confusion, linked to one or more triggering factors.

SUMMARY POINTS • Delirium is a common presentation of acute illness in older people • The development of delirium is associated with adverse outcomes • Delirium is characterised by recent onset of fluctuating inattention and drowsiness linked to triggering factors • Routine cognitive assessment in unwell older people would improve detection rates • Good research evidence exists that, with better systems of routine care, delirium could be prevented in at least a third of patients

Delirium is a major burden to healthcare services and has been largely ignored by health service planners and practitioners.¹ Moreover, . . . [Full text of this article]

Sources and selection criteria

How common is delirium?

What are the consequences of delirium?

What are the clinical features of delirium?

Box 1 Criteria for delirium, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV)⁸
Box 2 Hyperactive delirium
Scenario
Features
Box 3 Hypoactive delirium
Scenario
Features

How is delirium diagnosed?

Box 4 Confusion assessment method*^{13 14}
1 Acute onset and fluctuating course
2 Inattention
3 Disorganised thinking
4 Altered level of consciousness

The overlap between delirium and dementia

What are the causes of delirium?

Box 5 Common risk factors and precipitants for delirium
Risk factors
Precipitants (more than one may be present)
Drugs and delirium

Can delirium be prevented?

How can delirium be managed?

Conclusions

ADDITIONAL EDUCATIONAL RESOURCES
Resources for patients
Resources for healthcare professionals

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