Delirium

Presentation and immediate needs

An acute, often fluctuating disturbance of attention and awareness can be hyperactive, hypoactive or mixed. Quiet withdrawal can be as clinically important as agitation.

Begin assessment → History, examination and context

History, examination and context

Assess vital signs, oxygenation, glucose, hydration, pain and neurological findings as indicated. Establish baseline cognition and onset through collateral; review infection, medicines, intoxication and withdrawal.

Consider the branch → Acute or fluctuating change from the person’s baseline?

Acute or fluctuating change from the person’s baseline?

Use clinical findings and collateral. Uncertainty needs clarification, not a default negative answer.

Yes / concerning features → Priority assessment; No / not established → Formulation and care discussion; Uncertain / not assessed → Obtain the missing information

Priority assessment

Arrange prompt medical assessment and investigate precipitating causes.

After appropriate assessment → Formulation and care discussion

Obtain the missing information

Review the examination, timeline, relevant investigations and consented collateral. Escalate urgent concerns while uncertainty is resolved.

Reassess the branch → Acute or fluctuating change from the person’s baseline?

Formulation and care discussion

Prioritise assessment and treatment of underlying causes. Support orientation, hearing/vision access, hydration, nutrition, sleep and mobilisation. Medicines are not a substitute for cause-directed care.

Agree follow-up → Reassess and follow up

Reassess and follow up

Track fluctuation and resolution and revisit persistent cognitive problems after the acute illness. Explain the course to family and document the episode.