Nurse comforting patient

Delirium in older people

Episodes of delirium are most common among older patients

Information, guidance and tools to help you identify and manage episodes of delirium in older patients.

Delirium is a state of heightened mental confusion that commonly affects older people admitted to hospital. Ninety six percent of cases are experienced by older people. When older people with dementia experience severe illness or trauma such as a hip fracture they are more at risk of delirium.

Delirium causes great distress to patients, families and carers and has potentially serious consequences such as increased likelihood of admission to long term care and increased mortality.

People who have delirium may need to stay longer in hospital or in critical care; have an increased incidence of dementia and have more hospital-acquired complications such as falls and pressure ulcers.

Identifying delirium is an important priority as approximately half of all delirium episodes are potentially reversible, (Healthcare Improvement Scotland, 2013).

RCN publications

Commitment to Care of People living with Dementia - SPACE principles

This guidance sets out the five principles that form a shared commitment to improving care for people living with dementia and their families. The document is designed to be used in a wide range of health and social care settings and has included the most recent evidence and best practice. 

eBooks available from the RCN library

Alonso, R (2014) Delirium: Diagnosis, management and prevention, In Psychiatry - Theory, Applications and Treatments. New York: Novinka.

Page, V (2011) Delirium in critical care, Cambridge University Press.

Further delirium guidance and tools

Healthcare Improvement Scotland. Delirium toolkit. A range of tools and resources for healthcare professionals to help improve the identification and immediate management of delirium in clinical settings. 

HSC Public Health Agency. Delirium - information for patients and relatives (2016) This leaflet describes the causes and symptoms of delirium for patients and relatives.

National Institute for Health and Care Excellence. Delirium: Diagnosis, prevention and management (2010, last updated 2019)Advice that covers the care of adults with, or at risk of, delirium in hospital and in long-term residential care or a nursing home. 

National Institute for Health and Care Excellence. Quality standard (2014) Delirium in adultsLooks at the prevention, diagnosis and management of delirium in adults in hospital or long-term care settings.

NHS England. Dementia Revealed: What primary care needs to know - a primer for general practice (2014) A toolkit that looks at aspects of dementia, including delirium. 

SIGN. Risk reduction and management of delirium. This guideline provides recommendations based on current evidence for best practice in the detection, assessment, treatment and follow up of adults with delirium, as well as reducing the risk of delirium. 

Social Care Institute for Excellence and NICE (2017) Recognising and preventing delirium A quick guide for care home managers. This quick guide from NICE and SCIE will help care home managers and their staff to recognise the symptoms of delirium and to understand what they can do to prevent it.

Page last updated - 05/10/2020