Acute confusional States in the elderly--diagnosis and treatment.

BACKGROUND Delirium is common, has multiple causes and causes distress to numerous patients and their relatives. METHOD Selective review of the literature in PubMed and PsycINFO, with reference to selected national and international guidelines. RESULTS The hypoactive subtype of delirium is commoner than the hyperactive type, and often overlooked. Delirium in an elderly individual is associated with an additional burden, a possible loss of potential for rehabilitation, and a marked increase in mortality. The diagnosis of delirium is primarily clinical. All professionals involved in patient care must be able to recognize the features of delirium. Dementia, dehydration and polypharmacy are particularly strongly associated, in the elderly. A careful history and examination with appropriate investigation allows underlying causes to be detected and treated. Rehabilitation strategies should be initiated without delay. Neuroleptics and benzodiazepines have an established role in the pharmacological treatment even of the hyperactive subtype. Non-pharmacological treatments include the creation of a calm and patient centred environment, and the involvement of relatives. CONCLUSION In many cases, delirium can be diagnosed and treated in good time. Prevention is preferable to treatment.