DELIRIUM IN THE ELDERLY

Delirium is a common and serious neuropsychiatric syndrome in older adults, characterized by acute and fluctuating disturbances in attention, awareness, and cognition. It is associated with multiple adverse outcomes, including increased mortality, functional decline, long-term cognitive impairment, and institutionalization. This review synthesizes current knowledge on the pathophysiology, risk factors, clinical presentation, diagnosis, prevention, treatment, and prognosis of delirium in elderly patients. Delirium arises from complex interactions between predisposing vulnerabilities (such as dementia, frailty, and sensory deficits) and acute precipitants (including infections, medications, surgery, and environmental stressors), resulting in a transient but often severe breakdown of cerebral function. Diagnostic tools such as the Confusion Assessment Method (CAM) and 4AT improve detection, though challenges remain in hypoactive presentations and in patients with underlying dementia. Multicomponent non-pharmacological interventions - focused on orientation, sleep hygiene, mobilization, hydration, medication review, and sensory support - are the most effective preventive and therapeutic strategies. Pharmacological treatment, primarily with antipsychotics, is reserved for severe behavioral disturbances and does not alter the course of the syndrome. Delirium is a clinical red flag indicating systemic decompensation and should prompt both acute management and structured follow-up to mitigate long-term consequences. Greater integration of delirium screening and prevention into hospital protocols is essential to improve care outcomes in this vulnerable population.