"Poor historian" usually means we took a poor history.

Hand over the baseline, not just the numbers. The vital handover in delirium is the story: this is delirium not dementia, this is her normal, this is the cause, this is the plan. Without it the next team starts from zero. #delirium

Older acute patient with confusion. Myth: "I'll do the investigations first, then talk to family." Reality: Talking to family in parallel, or as early as possible, is crucial. It takes 2 minutes and can changes your entire diagnostic approach. #delirium #dementia

“She would lie in her bed really quietly. . . but she always had this frightened look on her face and when her family came to visit . . . they told us that . . . she felt really scared because she was seeing someone in the room with her.” #Delirium

Myth: Sedatives (like benzos) are mostly helpful in calming delirium. Fact: Sedatives often worsen delirium. Non-drug approaches (reorientation, hydration, mobility) are first-line treatments.

Pain can present as agitation in #delirium - assess and treat appropriately. Haloperidol is a poor analgesic.

The 4AT can be scored in patients who cannot speak or are too unwell to undergo cognitive testing. No patients are Unable To Assess (UTA) with the 4AT. This improves uptake and accuracy in diagnosis. See the 4AT website for more details.

As an Edinburgh doctor working in elderly care medicine, I have written to my Members of the Scottish Parliament urging them to vote against the Assisted Dying Bill. I can understand why people say they want this choice. But my central concern is the risk to vulnerable older people: some would choose this not because of unbearable suffering, but because they feel they are a burden on family. I do not believe safeguards can solve that. The bill would then mean the state authorising medical participation in the deliberate ending of the lives of patients who, in some cases, do not actually want to die - but feel pressure from others, or feel a duty not to burden their families. It would be a moral disaster if even one person chose assisted dying for that reason.

💡 One of the most important findings in delirium research in recent years, and I think it's still not widely enough known. The DECIDE study (Richardson et al, Age and Ageing 2021) followed 305 older adults from the population-based CFAS II-Newcastle cohort. They compared cognitive trajectories in three groups: hospitalised with delirium, hospitalised without delirium, and a matched group who weren't admitted to hospital at all. The hospitalised patients who didn't develop delirium had essentially the same cognitive trajectory as those who were never admitted. No significant difference. But those who developed delirium during their admission showed a 2.2-point MMSE decline at one year compared to the no-delirium group (P<0.001). Neither the number of admissions nor total length of stay were significant predictors. For years we've assumed that hospital admission itself is bad for the brain. This study suggests the real culprit is delirium. And delirium is something we can detect and, at least partly, prevent. That makes it potentially a modifiable risk factor for dementia - at least it means that we need to look into this more and explore the potential benefits of early detection and aggressive treatment aimed at protecting the brain. #medtwitter #dementia

"It's just the dementia progressing." A very dangerous phrase in clinical care. Acute change in someone with dementia? That's #delirium until proven otherwise. ↳ Don't put the stick in the patient's wheel. #Delirium #Dementia

The word "delirium" comes from Latin: *de-lira* — "out of the furrow." Like a plough going off track. Delirium is an abrupt departure from the person's normal path. To recognise it, you need to know what their path was before. #delirium

⭐ New delirium resource: 50 free clinical cases to practice 4AT #delirium scoring 12 healthcare settings. 3 difficulty levels. Read the case, note your score, then click 'Show Worked Solution'. No login. No ads. Just learning. Please RT & share with colleagues! Link 👇

"You can't properly assess for delirium when someone already has dementia." Wrong. New meta-analysis (Keane et al. 2026): 4AT shows 88% sensitivity, 79% specificity in dementia populations. 5 studies. 1,304 patients. International data. #delirium #dementia

⭐ META-ANALYSIS: Hospital delirium --> devastating long-term outcomes 253 studies, 137,000+ pts: • 5.4x dementia risk • 2.8x institutionalisation • 2.5x mortality • 1.7x readmission ⚠️ Delirium = a serious acute problem AND a risk warning. ➡️ All pts deserve robust delirium assessment