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Acute Confusion (Delirium)
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Elderly people seem particularly likely to develop confusion in response to a wide range of stimuli - either physical insults or sudden social change. This presumably reflects the reduced ability of the aged brain to cope with such events, particularly if it is additionally damaged by a dementing process. An acute confusional episode may sometimes be the first evidence of an underlying dementia. Elderly patients with acute confusion are seen throughout medical practice, e.g. 20% of all acute medical ward admissions are found to be acutely confused. In elderly people apathy, under-activity and clouding of consciousness are more common presentations of delirium than the florid, overactive restless, hallucinating states usually described in relation to younger patients. Causes include:
- Intercurrent physical ill-health
- Adverse reaction to a prescribed drug or drugs
- Catastrophic social situations, e.g. a move into residential care
Acute confusion should be regarded as indicative of underlying disease and investigated medically. Untreated it has a 40% mortality rate.
The clinical approach is to complete a full physical examination looking for evidence of infection, stoke, MI or other illness. A review of medication should focus on drugs started or stopped recently. Until the underlying cause is determined and treated, a small dose of an antipsychotic agent may reduce the severity of delirious episodes.
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