ABSTRACT
Initial assessment should exclude non-confusion disorders such as dysphasia and deafness. The key causes of cognitive impairment in the frail elderly are delirium and dementia. Confusion is an important problem in acute hospitals in several ways. First, it is a common reason for elderly people to present to services, where a rapid assessment and treatment plan is necessary to aid speedy recovery and reduce the risk of complications. Second, many cases that present differently will be complicated by co-existent confusion. An elderly patient presenting to medical services with new or worsened confusion should be assumed to have delirium, with or without background dementia, until proven otherwise. Delirium is the medical term for an acute confusional state. Delirium usually occurs in susceptible individuals exposed to precipitating circumstances. A chest X-ray should be obtained in all acutely confused elderly patients to look for signs of pneumonia.
