Delirium in the elderly: A review and a suggestion for a research programme

Delirium in the elderly attracts sporadic attention in the literature yet constitutes a major challenge to health services, complicating many illnesses and procedures in elderly patients, associated with high rates of mortality, cutting across disciplinary boundaries and posing theoretical difficulties for the organic/functional distinction that pervades medicine. In this review the importance of delirium in the elderly is emphasized, drawing attention to the suffering caused to the patient and the excess mortality. Problems of nomenclature (why use one word when three will do?) are discussed, the conclusion being that the oldest term is probably the best, provided that the concept of a ‘syndrome’ is preserved. Difficulties in research assessment are identified, and aetiology and the relationship of the delirium syndrome to dementia syndromes are discussed. Deficiencies in past approaches to management are identified and a definition of delirium is suggested. Finally, a proposal for a research programme is outlined.