Intended for healthcare professionals

Practice Easily Missed?

Delirium in older adults

BMJ 2013; 346 doi: (Published 09 April 2013) Cite this as: BMJ 2013;346:f2031
  1. Edison I O Vidal, assistant professor1,
  2. Paulo J F Villas Boas, associate professor1,
  3. Adriana P Valle, associate professor1,
  4. Ana Teresa A R Cerqueira, associate professor2,
  5. Fernanda B Fukushima, assistant professor3
  1. 1Internal Medicine Department, Universidade Estadual Paulista (UNESP), 18618-970 , Botucatu, SP, Brazil
  2. 2Neurology, Psychiatric and Psychology Department, Universidade Estadual Paulista (UNESP), 18618-970, Botucatu, SP, Brazil
  3. 3Anesthesiology Department, Universidade Estadual Paulista (UNESP), 18618-970, Botucatu, SP, Brazil
  1. Correspondence to: E I O Vidal eiovidal{at}
  • Accepted 4 January 2013

The daughter of an 80 year old woman with severely impaired vision from age related macular degeneration and diabetic retinopathy brought her mother to her primary care doctor, as she had been more apathetic and rejecting her meals in the past few days. Her daughter said there were times during the day when her mother looked almost her usual self, yet other times when she was confused and did not seem to be herself. Her doctor diagnosed delirium and referred the patient for assessment at the local emergency department.

What is delirium?

Delirium is a neuropsychiatric syndrome characterised by disturbances of cognition, attention, consciousness, or perception that develop over a short period of time (hours to days) with a fluctuating course.1 2 It usually results from the interaction of several precipitating factors (such as drugs, infections, metabolic disturbances, and myocardial infarction) and predisposing factors (such as old age, dementia, and multiple comorbidities).2 There are three subtypes of delirium, according to its psychomotor features: hyperactive, hypoactive, and mixed.

How common is delirium?

  • Among individuals aged 85 years and older living in the community the prevalence of delirium can be as high as 14%2

  • Among older people (aged 65 years and over), delirium usually occurs in 10-34% of those living in long term care facilities,3 in 30% of those in emergency departments,2 and in 10-42% during a hospital stay4

  • Delirium complicates 17-61% of major surgical procedures and occurs in 25-83% of patients at the end of life2 5

  • Despite the prevalence of delirium, healthcare professionals recognise only 20-50% of cases5

Why is delirium missed?

The fluctuating nature of the symptoms of delirium, its frequent …

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