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Alasdair M. J. MacLullich

, Edward R. Marcantonio

, and David J. Meagher

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date: 23 May 2022

Delirium is a complex medical emergency affecting at least 15% of older hospitalized patients. It causes considerable patient and carer distress, and is associated with adverse outcomes including falls, increased length of stay, new institutionalization, new and exacerbated long-term cognitive impairment, and mortality. Causes include medical illness, trauma, surgery, psychological stress, and drugs. The mechanisms involve direct effects on the brain such as hypoxia, and likely altered inflammatory and stress pathways. Older age, neurodegeneration, and medical comorbities greatly increase vulnerability. Detection involves eliciting evidence of acute inattention, altered level of arousal, and/or psychosis; brief tools such as the 4AT can improve detection rates. Care involves multiple aspects: treating all precipitating causes, optimizing general care, communicating with patients and carers, preventing complications, and treating distress and agitation. Detection of undiagnosed underlying dementia is important. Risk reduction in vulnerable patients, involving optimizing medical status, the care environment, and patient experience, is effective.

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