Geriatric Emergency Medicine Fellowship Journal Club: Operational Changes for Recognizing Prevalent Delirium and Preventing Incident Delirium

Delirium is an acute fluctuating condition characterized by an alteration in the level of consciousness associated with inattention and disorganized thinking. Delirium is known to cause increased morbidity and mortality in older adults. It has been associated with prolonged hospitalizations,1 functional decline,2 and cognitive decline.3 Delirium can either be present on arrival to the ED, early during the ED course (prevalent delirium), or develop during hospitalization in a patient who was initially not delirious in the ED (incident delirium). Delirium is missed in >50% of cases when screening is not performed.4-5 In addition, approximately 25% of older adults with delirium are discharged from the ED.6 Therefore, delirium screening, as well as mitigation of ED risk factors, are imperative to patient care. For this installment of the Geriatric Emergency Medicine Fellowship Journal Club, we reviewed two articles related to delirium risk to understand which patients are at risk of developing delirium after arriving in the ED and what strategies could be considered in the ED to prevent the development of incident delirium.