Prevention, diagnosis, referral and management of delirium in older people

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Delirium (acute confusional state) is a common condition in the elderly, affecting up to 30% of all older patients admitted to hospital. The hospital environment often precipitates or exacerbates episodes of delirium. Patients who develop delirium have high mortality, institutionalisation and complication rates and have longer lengths of stay than non-delirious patients. Delirium is often not recognised by clinicians and is often poorly managed.

Recent evidence, however, demonstrates that improved understanding of delirium among health professionals and improved attention to the environment around at-risk patients can both prevent the onset of delirium and curtail episodes that do arise. The appropriate management of older people at risk of delirium or who develop delirium will greatly enhance the quality of life for individuals and will be cost effective for the NHS in terms of resources required for the management of delirium and patients' length of stay.

This guideline was produced with the aim to provide hospital doctors, nurses, allied health professionals, care assistants, commissioners of services, relatives and carers with a practical approach to the identification, prevention and management of delirium. While developed primarily with a view to hospital care, the principles within the guideline are also highly relevant to intermediate and community care settings.