Acute confusion in an older adult is a sign of illness until shown otherwise. Look for infection, pain, urinary retention, constipation, dehydration, electrolyte and glucose disturbance, and recent medicine changes, especially anticholinergics, benzodiazepines and opioids.
Use non-drug measures first: reorientation, glasses and hearing aids, sleep, mobility and family presence. Reserve antipsychotics for distressing symptoms or risk to safety, at the lowest dose for the shortest time.
- Search for infection, pain, retention, constipation and metabolic causes.
- Review recently started anticholinergic, sedative and opioid medicines.
- Restore glasses, hearing aids, sleep and mobility.
- Use antipsychotics sparingly and review daily.
Why it matters
Delirium is a common and often reversible marker of acute illness in older people.
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