Advancing our diagnostic tools and treatment options for delirium

Delirium is one of the most prevalent and disabling conditions impacting older adults in hospitals and long-term care settings. The estimates of frequency of delirium in hospitals and nursing homes among older adults range widely, yet it is safe to assume that perhaps as many as 25-30% of elderly individuals in hospitals experience an episode of delirium, often undetected unless a regular screening process is implemented. Until the past couple of decades, actual research into delirium had been sparse and done little to inform clinical practice. Engel and Romano (1959) published a classic review nearly 60 years ago, which served for decades as the foundational article for understanding delirium. In recent years, however, our understanding of delirium has increased dramatically, from the basic neuropathological underpinnings through screening and diagnosis to treatment. In this issue of International Psychogeriatrics, five papers are published, which further expand our knowledge of delirium. The papers cover a range of topics including the frequency of delirium in a primary care setting, outcomes predicted by various diagnostic systems, cognitive function measures as they relate to delirium motor subtypes, screening for delirium using a standardized drug screen, and the effectiveness of multimodal interventions for preventing delirium in older hip fracture patients. What are the take home lessons from these studies?