Clinical investigations from the RACP

Investigating acute confusion in the elderly

Simon MK Chalkley, Sarah Baldwin



This is a general approach to investigating delirium in elderly people, including diagnosis, investigations, management options (including possible hospital admission) and follow up issues.

Key Points

  • Acute confusion or delirium in elderly people may indicate a serious underlying illness and afterwards may predict increased morbidity and mortality.
  • Patients aged over 80 years and with dementia, multiple medical problems and multiple medications are at particular risk of delirium.
  • An underlying cause or causes should be sought.
  • Management includes treatment of the underlying illness, antipsychotics when required and environmental support.
  • Admission to hospital is required when the causative illness requires inpatient management or patients are unable to be managed in their own environment.
  • Referral to a geriatrician may be indicated when confusion fails to improve over two to three weeks and when underlying dementia may be suspected.