Detection of delirium in the acute hospital

Abstract

SIR—Delirium remains a common, serious and under-recognised problem affecting older hospitalised patients. Despite being associated with poor longer-term outcomes, including death and institutionalisation [1], delirium remains disproportionately ignored relative to impact [2], and poor recognition remains the greatest obstacle to improved care and research [3]. It is ‘missed’ in up to two-thirds of cases [1]. Under detection of delirium may occur for a number of reasons; symptoms are heterogeneous and transient [1], and diagnosis is subjective relying on clinical skills in the absence of a diagnostic ‘test’ [2]. There is conflicting data on whether correct diagnosis is associated with demographic factors (male gender and older age [4]) or ethnicity [5]. Poorer English and education may decrease detection [6]. ‘Hypoactive’ delirium [7] with its less dramatic presentation and psychiatric co-morbidity may impede correct diagnosis, possibly through incorrect attribution of a psychiatric diagnosis [8, 9]. There is little published UK data, and previous work is limited by small numbers and under-reporting of co-morbid conditions [1]. We aimed to identify the patient characteristics associated with a correct detection of delirium in older patients with unplanned acute medical admissions.