Alasdair MacLullich

Mrs Smith, 78, hip fracture patient, described as "confused & aggressive"

Ward round note: "?UTI. Start antibiotics." No mention of "delirium"

My reaction: What about her distress - untreated pain? Dehydration? Medication review? Telling the family the diagnosis? Etc.

Why we need Delirium 8 👇

The 4AT can be scored in patients who cannot speak or are too unwell to undergo cognitive testing. No patients are Unable To Assess (UTA) with the 4AT. This improves uptake and accuracy in diagnosis.

See the 4AT website for more details.

We all should be using tools to detect #delirium.

But not all tools perform well in practice - some show much lower rates of detection in the real-world than in practice.

-- check tool performance -- it's not enough to implement & achieve good completion rates.

Health tips for older adults.

#medtwitter

When speaking to person describing delusional beliefs, listen without interrupting or dismissing their experiences. Instead of immediately correcting them, say something calm and neutral like:

“That must be very frightening for you.”'

#delirium

When a person in hospital is restless then it often means they are experiencing #delirium.


→ Look carefully at their facial expressions - see if they might be seeing things that are not real.

→ Sometimes asking them - "are you seeing anything strange or frightening?" can help.

All these informal terms - avoiding saying "delirium" - makes care FAR less effective.

Use #DELIRIUM.

"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 = 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 #medtwitter

Haloperidol is a very poor treatment for urinary retention.

When a person looks agitated, systematically check for direct causes of distress.

#delirium

A quote from a family member of a patient with delirium: "grieving for someone who's still alive."

Caring for loved ones with delirium, especially if it is persistent, can be stressful & exhausting.

Professionals should provide support to families as well as patients.

"I see her, she’s talking to me, she’s alive!" (Hallucinating under medication)

Taxi Driver, Martin Scorcese

“Nobody used the word delirium. I thought I’d lost my mind.”

— Delirium survivor


➡️ Always provide clear information, including telling the patient they have delirium, during the episode. Then explain & de-brief afterwards.

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

More than 1 in 3 older inpatients in this study were dehydrated.

Dehydrated patients: 13% higher odds of falling (OR 1.13, P=.002).

↳ Dehydration is cheap to fix - but easy to miss.



💧💧💧💧💧💧💧💧



⇉ Do you check fluid status on every ward round?

“He has had some fearful shock - so says our doctor - and in his #delirium his ravings have been dreadful, of wolves and poison and blood, of ghosts and demons, and I fear to say of what.”


Bram Stoker - Dracula (1897)

Older acute patient with confusion.

Myth: "I'll do the investigations first, then talk to family."

Reality: Talking to family in parallel, or as early as possible, is crucial. It takes 2 minutes and can changes your entire diagnostic approach.

"I can't remember" – Patients who have had #delirium often experience a feeling of 'lost time'. You can help by clearly explaining what delirium is & answering their questions. Give them a narrative of what has happened to them.

Family members concerned that their relative in hospital has delirium should assertively approach healthcare professionals and say, ""I think my relative has delirium."

Unfortunately #delirium is still missed, and informed families play an important role in advocating for their loved ones.

#delirium

Every hospital should have a delirium champion. We have stroke and sepsis champions - why not #delirium?

#PatientSafety

🧠 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

"Have you been having a difficult time?"

"Is there anything I can do to help you?"



➡️ Questions to help provide comfort to those with #delirium & #dementia

This image captures what many patients actually experience. Delusions - false beliefs that feel completely real - affect up to 1 in 3 older hospital patients with delirium.

A gentle question that can help: "Can you tell me where you think you are right now?"



#Delirium

Clinical tip on #delirium: involve the multidisciplinary team, including physiotherapy, occupational therapy & pharmacy.

The Nursing Delirium Screening Scale (NuDESC). Designed for inpatient monitoring for new #delirium.

Physical activity for adults & older adults

A feeling of loneliness or isolation is commonly reported in people experiencing #delirium.

Don't leave them feeling like this. Speak kindly, explain what is happening, involve family.

"It wasn't until a geriatrician reviewed my mother's medications that we found the cause of her sudden confusion. A new sleeping pill... Within two days of stopping it, she was back to her old self."

#delirium

Some studies show that in some undergraduate degrees nurses get no formal #delirium training.

For an emergency that affects 1 in 6 hospital patients.

Help me understand why this is.