For Healthcare Professionals

At least 20% of patients over 65 years of age hospitalized each year in the US experience complications during hospitalization because of delirium. While delirium can occur at any age, the geriatric population is particularly prone to delirium and its complications.

Delirium Prevalence graphicThe prevalence rates of delirium are complex and confusing because they are highly dependent upon the population that is being studied, and the setting in the hospital these patients are in.

Despite these surprisingly high rates of delirium in hospitalized patients, it goes unrecognized in 1/3 to 2/3 of cases.

A number of factors contribute to the under-recognition of delirium including:

  • Fluctuating Course
  • Frequent Overlap with Dementia
  • Lack of formal cognitive assessment
  • Delirium has a heterogeneous presentation
  • Lack of appreciation of its clinical consequences

Delirium is diagnosed based on the cognitive and behavioral symptoms associated with this syndrome:

DSM 5 Diagnostic Criteria for Delirium:

  • Disturbance in attention and awareness
    • Reduced ability to direct, focus, sustain, and shift attention
    • Reduced orientation to environment
  • The disturbance represents a change from baseline attention and awareness
    • The disturbance develops over short period of time (hours to few days)
    • The disturbance tends to fluctuate in severity during course of day
  • An additional disturbance in cognition
    • Memory deficit, disorientation, language, visuospatial ability, or perception
  • These disturbances are not better explained by a pre-existing, established, or evolving neurocognitive disorder
  • There is evidence that these disturbances are a direct physiological consequence of another medical condition, substance intoxication or withdrawal or exposure to a toxin.

Delirium Development graphicAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.

Therefore, the treatment of delirium must be multimodal; one of the cornerstones of the Mount Sinai Hospital Delirium Program.