Delirium. Pragmatic guidance for managing a common, confounding, and sometimes lethal condition.

Virtually any medical illness, intoxication, or medication can precipitate delirium, an acute confusional state common among older persons. Delirium is associated with a high risk of morbidity and mortality, thus management requires thorough assessment and swift but careful action. A range of nonpharmacologic interventions can aid management of delirium, but in general, emergent, empiric pharmacotherapy is indicated for acute cases. Key to assessment and diagnosis is ruling out dementia and depression, determining the presence of delirium, and establishing an underlying cause. Several screening tools are available to aid this effort. Vigilance can help reduce the high number of patients discharged with unresolved symptoms.