Delirium in elderly people
Open accessAbstract
Delirium is an acute disorder of attention and cognition in elderly people (ie, those aged 65 years or older) that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological risk factor approaches are the most effective strategy for prevention. No convincing evidence shows that pharmacological prevention or treatment is effective. Drug reduction for sedation and analgesia and non-pharmacological approaches are recommended. Delirium offers opportunities to elucidate brain pathophysiology--it serves both as a marker of brain vulnerability with decreased reserve and as a potential mechanism for permanent cognitive damage. As a potent indicator of patients' safety, delirium provides a target for system-wide process improvements. Public health priorities include improvements in coding, reimbursement from insurers, and research funding, and widespread education for clinicians and the public about the importance of delirium.
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Delirium has estimated direct health care costs over US $164 billion a year in the United States.
“with estimated direct health care costs over US $164 billion a year in the United States [11,13,14].”
From A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study (2019) · cites this paper as [13]
The Introduction reports that delirium costs over $164 billion per year in the United States, in 2011 dollars. It does not specify that this figure represents direct health care costs, so that qualifier is not established by our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredDelirium significantly increases the risk of falls in the hospital setting.
“Delirium significantly increases the risk of falls in the hospital setting [11,13,14].”
From A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study (2019) · cites this paper as [13]
The Future Directions and Recommendations section links delirium to falls, and Evaluation and Work-Up recommends preventing falls while caring for patients with delirium. Neither passage establishes that delirium significantly increases fall risk specifically in hospitals; no page numbers are available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredDelirium contributes to falls, cognitive decline, disability, morbidity, and mortality.
“delirium contributes to falls, cognitive decline, disability, morbidity, and mortality”
From A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study (2019) · cites this paper as [13]
The Epidemiology section links delirium to cognitive and physical impairment and increased mortality; the Introduction describes downstream complications, while Future Directions links delirium to falls and functional decline. The claim’s wording is stronger than the source on falls and mortality: it reports links or associations, not that delirium causes those outcomes. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDelirium is associated with higher risks of functional decline, cognitive impairment, prolonged hospital stay, institutionalization, and mortality.
“Delirium, a significant neuropsychiatric condition characterized by acute and fluctuating disturbances in attention, perception, awareness, and cognition, is associated with higher risks of functional decline, cognitive impairment, prolonged hospital stay, institutionalization, and mortality [535,536].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [535]
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Self-citationPostoperative Delirium in Intensive Care Patients: Risk Factors and Outcome
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Neuropsychiatric Adverse Effects of Antiparkinsonian Drugs
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Impact of glucocorticoids on brain function: Relevance for mood disorders
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MacLullich, A. M. J., Edelshain, B. T., Hall, R. J., de Vries, A., Howie, S., Pearson, A., Middleton, S. D., Gillies, F., Armstrong, I. R., White, T. O., et al. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03428.x · Cited by 70 · see citing works
Cerebrospinal Fluid in Long-Lasting Delirium Compared With Alzheimer's Dementia
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Diagnostic yield of cerebral imaging in patients with acute confusion
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Capturing side-effect of medication to identify persons at risk of delirium
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An intervention for delirium superimposed on dementia based on cognitive reserve theory
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Role of microglia and toll-like receptor 4 in the pathophysiology of delirium
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The Neuropsychology of Psychopathology
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Delirium and confusional states.
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Delirium in the acute phase after stroke: Incidence, risk factors, and outcome
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Delirium in Older Persons: Advances in Diagnosis and Treatment
Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K. (2017) · JAMA · doi:10.1001/jama.2017.12067 · Cited by 926 · see citing works
Self-citationEffectiveness of Multicomponent Nonpharmacological Delirium Interventions: A Meta-analysis
Hshieh, T. T., Yue, J., Oh, E., Puelle, M., Dowal, S., Travison, T., & Inouye, S. K. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.7779 · Cited by 801 · see citing works
Self-citationThe interface between delirium and dementia in elderly adults
Fong, T. G., Davis, D., Growdon, M. E., Albuquerque, A., & Inouye, S. K. (2015) · The Lancet Neurology · doi:10.1016/s1474-4422(15)00101-5 · Cited by 595 · see citing works
Self-citationAssociation of Delirium With Long-term Cognitive Decline: A Meta-analysis
Goldberg, T. E., Chen, C., Wang, Y., Jung, E., Swanson, A., Ing, C., Garcia, P. S., Whittington, R. A., & Moitra, V. (2020) · JAMA Neurology · doi:10.1001/jamaneurol.2020.2273 · Cited by 606 · see citing works
Neufeld, K. J., Yue, J., Robinson, T. N., Inouye, S. K., & Needham, D. M. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14076 · Cited by 505 · see citing works
Self-citationInouye, S. K., Marcantonio, E. R., Kosar, C. M., Tommet, D., Schmitt, E. M., Travison, T. G., Saczynski, J. S., Ngo, L. H., Alsop, D. C., & Jones, R. N. (2016) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2016.03.005 · Cited by 462 · see citing works
Self-citationHospital elder life program: systematic review and meta-analysis of effectiveness
Hshieh, T. T., Yang, T., Gartaganis, S. L., Yue, J., & Inouye, S. K. (2018) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2018.06.007 · Cited by 466 · see citing works
Self-citationThe inter-relationship between delirium and dementia: the importance of delirium prevention
Fong, T. G., & Inouye, S. K. (2022) · Nature Reviews Neurology · doi:10.1038/s41582-022-00698-7 · Cited by 404 · see citing works
Self-citationPublic Health Challenges and Responses to the Growing Ageing Populations
Khan, H. T. A., Addo, K. M., & Findlay, H. (2024) · Public Health Challenges · doi:10.1002/puh2.213 · Cited by 298 · see citing works
Izquierdo, M., de Souto Barreto, P., Arai, H., Bischoff-Ferrari, H. A., Cadore, E. L., Cesari, M., Chen, L.-K., Coen, P. M., Courneya, K. S., Duque, G., et al. (2025) · The Journal of nutrition, health and aging · doi:10.1016/j.jnha.2024.100401 · Cited by 273 · see citing works
Wu, Y.-C., Tseng, P.-T., Tu, Y.-K., Hsu, C.-Y., Liang, C.-S., Yeh, T.-C., Chen, T.-Y., Chu, C.-S., Matsuoka, Y. J., Stubbs, B., et al. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.4365 · Cited by 148 · see citing works
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Jackson, T. A., Wilson, D., Richardson, S., & Lord, J. M. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4344 · Cited by 100 · see citing works
Interventions for preventing delirium in older people in institutional long-term care
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2- <sup>18</sup> F-fluoro-2-deoxyglucose positron emission tomography in delirium
Haggstrom, L. R., Nelson, J. A., Wegner, E. A., & Caplan, G. A. (2017) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x17701764 · Cited by 78 · see citing works
Continuity of GP care for patients with dementia: Impact on prescribing and the health of patients
Delgado, J., Evans, P. H., Gray, D. P., Sidaway-Lee, K., Allan, L., Clare, L., Ballard, C., Masoli, J., Valderas, J. M., & Melzer, D. (2022) · British Journal of General Practice · doi:10.3399/bjgp.2021.0413 · Cited by 70 · see citing works
“32,33 The findings in the current study are consistent with previous studies asserting that higher continuity of GP care is associated with reduced rates of admission to hospital for patients with dementia, 34,35 and for older patients in general.”
Investigating Ketone Bodies as Immunometabolic Countermeasures against Respiratory Viral Infections
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“One in 3 older adults reports loneliness in the United States [2], and a recent American Association of Retired Persons (AARP) survey found that approximately 42.6 million older adults suffer from chronic loneliness [3]; research demonstrates that loneliness is linked to a variety of negative health outcomes, includin…”
InfluentialA complication of coronavirus disease 2019: delirium
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Quality of clinical practice guidelines in delirium: a systematic appraisal
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Cognitive Reserve and Postoperative Delirium in Older Adults
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Cerebrospinal Fluid Levels of Interleukin-8 in Delirium, Dementia, and Cognitively Healthy Patients
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Sáez de Asteasu, M. L., Cuevas-Lara, C., García-Hermoso, A., Ramírez-Vélez, R., Martínez-Velilla, N., Zambom-Ferraresi, F., Cadore, E. L., & Izquierdo, M. (2022) · Journal of Alzheimer's Disease · doi:10.3233/jad-220103 · Cited by 28 · see citing works
Characteristics and Outcome Determinants of Hospitalized Older Patients with Cognitive Dysfunction
Chao, Y.-T., Kuo, F.-H., Lee, Y.-S., Huang, Y.-H., Weng, S.-C., Chou, Y.-Y., Lin, C.-S., & Lin, S.-Y. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010584 · Cited by 14 · see citing works
Gilmore-Bykovskyi, A. L., Block, L., Hovanes, M., Mirr, J., & Kolanowski, A. (2019) · Research in Gerontological Nursing · doi:10.3928/19404921-20190122-01 · Cited by 11 · see citing works
Sleep Medicine - Asleep or Awake?
(2024) · doi:10.5772/intechopen.104201 · Cited by 5 · see citing works
- Authors
- Inouye, S. K., Westendorp, R. G., & Saczynski, J. S.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Leiden University Medical Center (NL)
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- Inouye, Sharon K
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 383
- Issue
- 9920
- Pages
- 911-922
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC4120864
- OpenAlex
- W2141710162
- Cited by
- 3,722
- References
- 118
- Citations by year
- 2026: 354 · 2025: 397 · 2024: 376 · 2023: 328 · 2022: 385 · 2021: 386 · 2020: 340 · 2019: 307 · 2018: 237 · 2017: 213 · 2016: 184 · 2015: 131 · 2014: 67 · 2013: 2 · 2012: 3
- FWCI
- 14.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institute on Aging (P01AG031720)
- US National Institutes of Health (K01AG033643 and U01HL10526)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- delirium, older adults, cognitive impairment, delirium prevention, delirium risk factors, sedation reduction, non-pharmacological treatment, brain reserve, patient safety, clinician education
- MeSH terms
- Aged, Cognition Disorders, Delirium, Dementia, Humans, Prognosis, Risk Factors, Biomedical Research
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