Clinical investigations from the RACP

Investigation of acute confusion in the elderly

Suzanne Wass, Penelope J Webster, Balakrishnan (Kichu) R Nair



Delirium is common in elderly patients. It is often underdiagnosed and mismanaged leading to significant morbidity and mortality.

Key Points

  • Presume that every elderly patient with confusion has delirium until proven otherwise.
  • Early detection can be improved with the use of the Confusion Assessment Method and detailed history taking from family or carers.
  • Formulate individual nonpharmacological management plans, and reserve antipsychotic or sedative medication for those with the most distressing symptoms.
  • Education and support of families, carers and residential home staff is essential.
  • Ensure close follow up in the community and good communication between carers and primary care practitioners.