Delirium is common in older people admitted to hospital and is often missed, especially the quiet, hypoactive form. A brief validated tool such as the 4AT, which tests alertness, orientation, attention and acute change, can be done at the bedside in under two minutes. A positive screen should prompt a search for causes, including infection, drugs, retention, constipation, pain, dehydration and metabolic upset.
- Screen older adults on admission with a brief validated tool such as the 4AT.
- Ask the family whether thinking has changed recently.
- Look for hypoactive delirium in quiet, drowsy patients.
- Review medicines, especially anticholinergics, sedatives and opioids.
- Check for urinary retention, constipation and pain.
Why it matters
Hypoactive delirium is the form most easily mistaken for tiredness or dementia.
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