Sundowning on a sunny day in Cornwall

BMJ 2004; 329 doi: (Published 18 November 2004) Cite this as: BMJ 2004;329:1219
  1. Simon Noble (, specialist registrar in palliative medicine
  1. Velindre Hospital, Cardiff

    On 11 August 1999 the patients on an orthopaedic ward in Cornwall were restless. An acute confusional state in an elderly postoperative patient is not uncommon, but what is unusual is when half the occupants of a 28 bed unit lose the plot within five minutes of each other. The first to become muddled, at 10 15 am, said he wanted his bedtime cocoa. Then a woman who had been sharp as a button an hour earlier started getting disoriented. I had seen her that morning, and she had been fine. So why was she now screaming about the war and hiding behind the bed? A …

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