• Tony Rosen, Scott Connors, Sunday Clark, Alexis Halpern, Michael E Stern, Jennifer DeWald, Mark S Lachs, and Neal Flomenbaum.
• Division of Emergency Medicine (Drs Rosen, Clark, Halpern, Stern, and Flomenbaum, Mr Connors, and Ms DeWald) and Division of Geriatrics and Palliative Medicine (Mr Connors and Dr Lachs), Weill Cornell Medical College, New York.
• Adv Emerg Nurs J. 2015 Jul 1; 37 (3): 183-96; quiz E3.

AbstractDelirium occurs frequently in older patients in the emergency department (ED), is underrecognized, and has potentially serious consequences. Despite its seriousness, delirium is frequently missed by emergency providers, and patients with unrecognized delirium are often discharged from the ED. Even when it is appropriately recognized, managing delirium in older adults poses a significant challenge for ED providers. Geriatric delirium is typically caused by the interaction of multiple factors, including several that are commonly missed: pain, urinary retention, constipation, dehydration, and polypharmacy. Appropriate management includes nonpharmacological management with medication intervention reserved for emergencies. We have developed a new, comprehensive, evidence-based protocol for diagnosis/recognition, management, and disposition of geriatric delirium patients in the ED with a focus on identifying and treating commonly missed contributing causes.

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