Assessment and management of delirium in the elderly

Diagnosis. This is likely hypoactive delirium until proven otherwise — acute fluctuating change from baseline with reduced attention, not 'just dementia'; delirium remains underdetected without brief routine screens. Check finger-prick glucose early (already normal).^[2]

Screen and precipitants. Perform 4AT (alertness, AMT4, attention, acute change); CAM features: acute onset + inattention plus either disorganised thinking or altered consciousness — CAM enables non-psychiatric clinicians to detect delirium quickly in high-risk settings. Run the full DELIRIUM precipitant search (observations, septic screen, urine, bladder scan, rectal exam, electrolytes, ECG, CXR, medication review, CT head where indicated) — confirm the search list against local delirium protocol.^[1][2]

Management. Treat cause; reorient environment (glasses, hearing aids, lighting, family); avoid tethers; pharmacological choices per local delirium protocol — confirm agents and doses locally.^[2]

Disposition. Admit for cause treatment and safe care; document capacity and collateral — high-scoring answers name hypoactive delirium, reproduce 4AT/CAM, run a structured precipitant search, and state a non-drug-first ladder.^[1][2]