Delirium and acute confusion
Recognising acute confusion with the 4AT and CAM, hypoactive delirium, predisposing and precipitating factors, a targeted work-up, multicomponent prevention, why antipsychotics don't treat delirium, and follow-up for later dementia.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Delirium is an acute, fluctuating disturbance of attention and awareness caused by illness, drugs or withdrawal. It is a medical emergency in an older person, often the first sign of sepsis, retention or a drug problem.
- Present in roughly 10 to 30% of older people on admission, and much more common after hip fracture, in ICU and at the end of life.
- Screen everyone at risk with the 4AT. Assume new confusion is delirium, not dementia, until shown otherwise.
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Sources
- Delirium Clinical Care Standard (revised 2021)AU/NZAustralian Commission on Safety and Quality in Health Care, 2021
- Australasian Delirium AssociationAU/NZAustralasian Delirium Association
- Delirium: prevention, diagnosis and management in hospital and long-term care (CG103)National Institute for Health and Care Excellence, 2023
- Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis (Tieges Z et al. Age Ageing 2021;50:733-43)Age and Ageing, 2021
- Inouye SK et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999;340:669-76New England Journal of Medicine, 1999
- Reducing delirium after hip fracture: a randomized trial (Marcantonio ER et al. J Am Geriatr Soc 2001;49:516-22)Journal of the American Geriatrics Society, 2001
- Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis (Witlox J et al. JAMA 2010;304:443-51)JAMA, 2010
- Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care (Agar MR et al. JAMA Intern Med 2017;177:34-42)AU/NZJAMA Internal Medicine, 2017
- Girard TD et al. Haloperidol and ziprasidone for treatment of delirium in critical illness (MIND-USA). N Engl J Med 2018;379:2506-16New England Journal of Medicine, 2018
- Last updated
- 14 November 2026
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