Acute confusion or a sudden change in behaviour in an older adult is delirium until another cause is established, and it is a medical emergency with a cause to find. Look for infection, pain, urinary retention, constipation, dehydration, new or changed drugs, metabolic upset and hypoxia.
Re-orientation, glasses and hearing aids, sleep, mobility and a familiar environment help. Avoid sedatives unless there is danger, and review anticholinergic and sedative drugs.
- Treat sudden confusion as delirium and look for a precipitant.
- Check for infection, retention, constipation, dehydration, pain and drug changes.
- Make sure glasses and hearing aids are in use, and promote sleep and mobility.
- Avoid sedatives and anticholinergics where possible.
Why it matters
Delirium is often missed, and the underlying cause is frequently treatable.
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