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Delirium in older adults

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.

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?

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