Delirium is an acute decline in attention and cognition not better explained by another medical condition.1 It is multifactorial in origin, with risk factors including advanced age, male sex, baseline decreased cognitive status, sensory impairment, poor baseline functional status, polypharmacy, and multiple comorbid conditions. Acute precipitants for delirium include administration of psychoactive medications (particularly benzodiazepines, narcotics, anticholinergic medications, and general anesthesia), sleep deprivation, major surgery, and new illness or worsening of current illness.Delirium accounts for some 49% of all hospital days in older patients, increases rates of mortality and morbidity, and is associated with lasting cognitive impairment after discharge, even in younger patients.


  • Delirium, especially the hypoactive form, is an underrecognized and preventable complication of hospitalization in elderly patients.
  • Advanced age, male sex, baseline cognitive impairment, polypharmacy, and multiple comorbidities are risk factors for development of delirium.
  • Reorientation, institution of a non-pharmacologic sleep protocol, getting the patient out of bed, encouraging the use of glasses/hearing aids, and encouraging fluid intake result in lower rates of delirium in hospitalized elderly.
  • Antipsychotic medications should only be used when necessary to prevent harm to the patient and should be initiated at a very low dose (0.25 mg IV is the recommended starting dose of haloperidol).