"Dementia is a disability. People with #dementia have the right to be treated with dignity and respect, and to receive the care and support they need to live well."
— Alzheimer's Disease International (ADI)
Clinical tip on #delirium: involve the multidisciplinary team, including physiotherapy, occupational therapy & pharmacy.
Always, always ask: Why is this person delirious? If they are showing agitation - always check for pain, retention, constipation, thirst, etc.
#Delirium #PatientSafety #Geriatrics #MedEd #Pain #Hospitalist #EmergencyMedicine #InternalMedicine #Dementia
Delirium is very common, affecting about 1 in 4 older people in the hospital.
Yet many members of the public have never heard of it or don't link it to a medical condition.
Professionals should always use the term "delirium" & provide clear explanations.
Early recognition & treatment of #delirium leads to faster recovery.
RCT.
"At any one time 1 in 4 hospital beds are occupied by people living with #dementia. People with dementia often experience longer hospital stays, delays in leaving hospital and reduced independent living."
— UK NICE Guideline on dementia
Clinical tip on #delirium: symptoms of delirium can fluctuate. A person might have lucid periods and then, an hour later, be obviously confused again. This coming and going is characterisic of delirium.
#Delirium treatment is much more complex: treat the cause(s) - usually more than 1, optimise physiology (e.g. hydrate), detect & treat distress, prevent complications (e.g. falls, pressure sores, aspiration), communicate with family, rehabilitate, etc.
#meded
Sometimes when the triggers of #delirium are not clear on with standard history & examination, a head-to-toe approach can help to uncover causes.
2 millenia & counting. Hippocrates knew #delirium was a medical emergency.
Why is it still so often missed, misdiagnosed, or undertreated?
What are the barriers?
What are the solutions?
🙁 "Nobody told me or my family about delirium during my whole time in the hospital. Not the doctors, nurses, support workers - no one mentioned it."
-- Delirium survivor
⭐ Communication with patients & families about the diagnosis of delirium is ESSENTIAL for good care.
#delirium #medtwitter
"Many staff feel undertrained and lack confidence in dealing with cognitive disorders, and associated problems such as distress, agitation and aggression, resistance to care, exit-seeking or calling out."
— British Geriatrics Society
The 4AT doesn’t require special training. It's a simple tool made for bedside care.
Try it here (interactive calculator): www.the4AT.com/trythe4AT
Noting that a patient is "confused" just isn't enough.
Don't assume any cognitive impairment is dementia - it may be delirium.
A brief conversation with the family can provide critical information.
#Delirium
Let's always slow down & think carefully about the experience of our patients with #delirium.
Do they look worried/distressed/frightened?
"It's just the dementia progressing."
A very dangerous phrase in clinical care.
Acute change in someone with dementia? That's #delirium until proven otherwise.
↳ Don't put the stick in the patient's wheel.
#Delirium
Haloperidol is a very poor treatment for urinary retention.
When a person looks agitated, systematically check for direct causes of distress.
#delirium
"End of life care for dementia is different to care for other terminal conditions. People with dementia aren't always able to express what's troubling them – that could be pain, anxiety, fear."
— Marie Curie Charity
Questions to help to see if a person with #delirium may have delusions:
"Do you feel that everyone is treating you well? Do you feel safe here?"
#MedEd
“She would lie in her bed really quietly. . . but she always had this frightened look on her face and when her family came to visit . . . they told us that . . . she felt really scared because she was seeing someone in the room with her.”
#Delirium
Why are we building complex AI systems to detect delirium from casenotes when we could just... do a 2-minute bedside test?
The 4AT exists.
It's well-validated (33 studies).
It's free.
Sometimes clinical medicine doesn't need machine learning.
#delirium
Direct yet gentle questioning on hallucinations for people with #delirium:
"Have you noticed anything odd recently, like seeing unusual or unexpected things?"
"Identifying the presence of cognitive impairment early is essential to manage the safety and quality risks, reduce harm and improve the healthcare outcomes for older patients during and after a hospital stay."
— Australian Commission on Safety and Quality in Health Care
"You can't properly assess for delirium when someone already has dementia."
Wrong.
New meta-analysis (Keane et al. 2026): 4AT shows 88% sensitivity, 79% specificity in dementia populations.
5 studies. 1,304 patients. International data.
#delirium #dementia
🧠 Delirium is the only dedicated delirium journals
👍100% open access.
👍Ultra-low fees ($20 submission, $280 publication).
👍All study types welcome & rapid 4-week peer review.
#delirium
Pain can present as agitation in #delirium - assess and treat appropriately.
Haloperidol is a poor analgesic.
Clinical tip on #delirium: with agitation, de-escalate with a calm manner & express empathy, e.g. by saying, "You look worried - how can I help?"
"At every jolt he again felt unendurable pain; his feverishness increased and he grew delirious." - Leo Tolstoy, War and Peace
#delirium
Families: Caring for someone with #delirium is exhausting. Your wellbeing matters too. Take breaks, seek support, ask for help.
