Detection of delirium in the acute hospital

摘要

SIR—Delirium remains a common, serious and under-recognisednproblem affecting older hospitalised patients.nDespite being associated with poor longer-term outcomes,nincluding death and institutionalisation [1], delirium remainsndisproportionately ignored relative to impact [2], and poornrecognition remains the greatest obstacle to improved carenand research [3]. It is ‘missed’ in up to two-thirds of casesn[1]. Under detection of delirium may occur for a number ofnreasons; symptoms are heterogeneous and transient [1], andndiagnosis is subjective relying on clinical skills in the absencenof a diagnostic ‘test’ [2].nThere is conflicting data on whether correct diagnosis isnassociated with demographic factors (male gender and oldernage [4]) or ethnicity [5]. Poorer English and education mayndecrease detection [6]. ‘Hypoactive’ delirium [7] with itsnless dramatic presentation and psychiatric co-morbiditynmay impede correct diagnosis, possibly through incorrectnattribution of a psychiatric diagnosis [8, 9].nThere is little published UK data, and previous work isnlimited by small numbers and under-reporting of co-morbidnconditions [1]. We aimed to identify the patient characteristicsnassociated with a correct detection of delirium in oldernpatients with unplanned acute medical admissions.