Preventing delirium in older people.

Delirium is a common presentation of acute physical illness in older people. When complicating a hospital admission it is an independent predictor of poor outcomes and is poorly detected. Up to 50% of delirium in older people develops after admission to hospital. The factors that predispose to and precipitate these incident cases are now recognized and many are related to the process of care. Controlled studies demonstrate the potential to reduce incident delirium by 30-40%, and these interventions are essentially the provision of high-quality care. The routine use of risk prediction rules for all older people admitted to general hospitals would identify those at greatest risk and allow the implementation of care plans that incorporate strategies for prevention and the detection of early symptoms. There is now sufficient evidence to recommend that this should become routine practice.