Acute confusional state or Delirium

Acute confusional state is also known as delirium or acute organic brain syndrome. It affects up to 30% of elderly patients admitted to hospital.

Predisposing factors include:

• age > 65 years
• background of dementia
• significant injury e.g. hip fracture
• frailty or multimorbidity
• polypharmacy

The precipitating events are often multifactorial and may include:

• infection: particularly urinary tract infections
• metabolic: e.g. hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration
• change of environment
• any significant cardiovascular, respiratory, neurological or endocrine condition
• severe pain
• alcohol withdrawal
• constipation

Features - a wide variety of presentations

• memory disturbances (loss of short term > long term)
• may be very agitated or withdrawn
• disorientation