Delirium in hospitalized older patients: recognition and risk factors

Delirium, or acute confusional state, represents a common, serious, potentially preventable and increasing prob-lem for older hospitalized patients. This study is intended to improve overall understanding of the problem of delirium and thus to lessen its adverse impact on the older population. The specific aims of this study are (1) to exam-ine the epidemiology of delirium in older patients; (2) to evaluate barriers to recognition; (3) to present the Confusion Assessment Method (CAM) simplified algorithm to improve recognition; (4) to elucidate predisposing and precipi-tating factors for delirium; and (5) to propose preventive strategies. Delirium occurs in 10-60 % of the older hospitalized population and is unrecognized in 32-66 % of cases. The CAM algorithm provides a sensitive (94-100%), specific (90-95%), reliable, and easy to use means for identification of delirium. Four predisposing and five precipitating factors were identified and validated to identify patients at high risk for development of delirium. Primary pre-vention of delirium should address important delirium risk factors and target patients at intermediate to high risk for delirium at admission. (J Geriatr Psychiatry Neurol1998; 11:118-125). CASE MS was a 78-year-old woman, living independently prior to admission, with diabetes, arthritis, and cataracts