Delirium in the older person

Delirium is a sudden, fluctuating change in mental state, which disturbs thinking and attention, and results in changed behaviour.

If delirium is not recognized, it can lead to permanent disability or death.

This information is for anyone who supports an elder who develops a delirium – family members and health care professionals alike.

A Medical Emergency

Delirium is a change in mental state which comes on suddenly, fluctuates over 24 hours, alters consciousness, disturbs thinking and attention and results in changed behaviour. Symptoms include problems with attention, thinking, memory, psychomotor changes and disruption of the sleep-wake cycle (Lipowski, 1989; Ignatavicious, 1999; Bater, 2006; DSM-5, 2013). 

Delirium is considered a “medical emergency”

Delirium affects older persons in all areas of health care. All staff must be skillful in recognizing and responding to it.

The statistics are shocking. Despite the fact that Delirium is treatable,

In Acute Care:

  • 50% of older persons may develop delirium in hospital

  • 40-50% of older persons develop delirium after hip surgery

  • 70% of person 65+ admitted to intensive care (National Guidelines, 2014)

In Residential Care:

  • 22-89% of residents with dementia experience delirium (National Guidelines, 2014)

Delirium in the Older Person: A Family Guide 

Winner of a 2007 Gold Questar International Award for Video Communication.

Delirium in the Older Person: A Medical Emergency

Winner of the 2006 International Medical Media Award for Geriatrics (The Freddies) 

    Also Watch:

    Acute Care
    Residential Care
    Home and Community Care
    Delirium at End of Life


    • as a teaching tool to improve ability to recognize, assess and intervene with delirium
    • for formal education of staff, families and clients 
    • to learn about Delirium Watch and Elder Friendly programs in acute care
    • for case conferencing and discussion groups
    • as self-directed learning, at your convenience and at your own pace
    • conjunction with resources from this website

    Useful Links

    Canadian Coalition of Seniors Mental Health

    Tools for Seniors and Families, and for Clinicians, including the National Guidelines for Assessment and Treatment of Delirium and more:  

    RN Association of Ontario

    Nursing Best Practice Guideline and Caregiving Strategies for Older Adults with Delirium, Dementia and Depression. RNAO - Nursing Best Practices

    HealthLink BC

    Talk to a nurse by phone, or contact them for algorithms for delirium. In British Columbia, dial 8-1-1. 

    Acute Care Geriatric Nurse Network

    Delirium Clinical Practice Guidelines; links and resources from BC's Clinical Nurse Specialists in geriatrics, gerontology, geropsychiatry, and geriatric rehabilitation. 

    Institute for Health Care Improvement

    Delirium in ICU

    National Institute for Health Care Excellence


    Information about delirium for families and health care professionals, including tools, flow sheets, learning tools and professional practice information.

    About Delirium

    Delirium in the Older Person. Overview of delirium; tools for recognition, assessment and treatment of delirium are placed in context. This is a useful teaching handout. Bibliography.

    Quick Reference Tools

    Delirium Decision Tree 
    Quick Reference Guide 


    Island Health Delirium Clinical Standards Guidelines [Please contact us]
    Drugs that can Cause Delirium 
    You Can Prevent Delirium Poster 


    Information Pamphlet for Families 
    Information Pamphlet for Health Care Providers
    2 Ds Differentiating Delirium from Dementia
    3 Ds Differentiating Delirium from Dementia and Depression
    Physiological Changes with Aging
    Age-Related Changes


    Confusion Assessment Method (CAM)
    CAM Training Manual  
    CAM-ICU Training manual
    Laboratory Investigations
    Behaviour Monitoring Chart
    Sleep-Wake Monitoring Chart 
    Sleep Hygiene Log
    Symptom Screening
    Search for Cause (legal-size)


    Search for Solutions (legal-size)
    Hallucinations and Delusions

    Learning about Delirium: Take a Quiz

    Age-Related Changes (read before playing game below)
    Delirium Crossword
    2D Quiz Delirium, Dementia or Depression? - answer key included
    3D Quiz Delirium, Dementia or Depression? - answer key included
    Pre and Post Learning Test - answer key included

    Professional Practice Resources

    Acute Care

    The Assessment and Treatment of Delirium - Canadian Coalition for Seniors’ Mental Health 2014 Guideline Update
    Delirium Watch - Alert

    For additional tools used within Island Health, see Seniors Health or contact us.

    Delirium at End of Life

    End of Life Care National Health Service, U.K.


    The documents available on this Delirium website are designed as a general reference for dealing with delirium in the older person.

    The information contained herein was written for use within Island Health and we make no warranty, expressed or implied. While care has been taken to ensure accuracy of the information, it is not intended to provide medical advice or to replace the specific recommendations of physicians and other health team members. Since Best Practice and Standards of Care are constantly evolving, it is advised that this site not be used as the sole source of information. You are encouraged to also consult other current references.


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