Delirium – how can we tackle the most elusive giant?

One of the biggest social transformations of the 21 century is that of population ageing. It has been predicted that within the next decade the number of adults aged 65 and over will outnumber the number of children under the age of five (1). Moreover, by 2050, the number of adults world-wide aged over 80 will reach 395 million, a four-fold increase since the year 2000 (1). With these changes in demographics come new healthcare challenges. The principal categories of impairment in old age which impact on the physical, mental and social wellbeing of older adults were described by Professor Bernard Isaacs as the “geriatric giants”, namely instability, immobility, incontinence and intellectual impairment (2). It is a common misconception that these conditions are an unavoidable part of ageing. However, they are often in fact non-specific initial presentations of acute illness and they can frequently be improved.