Delirium in older patients

Delirium, which has numerous synonyms, including acute brain failure and altered mental status, is one of the most diverse and complex syndromes in medicine, especially for older patients. As a syndrome with common outward expressions of the underlying causes and contributors, non-pharmacologic preventive and management strategies do exist that can help clinicians care for older patients with delirium. Rates of delirium vary depending on the population and the clinical scenario. The negative consequences associated with delirium have been well studied for several decades now. These include hospital complications, loss of physical function, increased need for institutional care after hospitalization, poorer outcomes at skilled nursing facility, increased length of stay, increased mortality, post-traumatic stress disorder, and depression. Historically, and perhaps too simplistically, the delirium phenotypes have been categorised as hypoactive, hyperactive, or mixed. There are many predisposing and precipitating factors to delirium. Following identification and management of these, nonpharmacologic management measures should be instituted.