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Hypoactive delirium after hip fracture — SCE Acute Medicine MCQ

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ModerateMedicine in the elderlyHypoactive delirium after hip fractureSCE Acute Medicine

A 91-year-old woman admitted with a hip fracture becomes quiet and withdrawn on the ward. She is inattentive, eating poorly and sleeping during the day; pain score is high when moved, bowels have not opened for 4 days and sodium is 130 mmol/L. There is no aggression. What is the most appropriate next step in management?

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Correct answer: A — Assess and treat reversible delirium triggers using multicomponent non-drug measures

Hypoactive delirium is common and easily missed in older inpatients; pain, constipation, dehydration, infection and electrolytes should be addressed with multicomponent prevention and management. Antipsychotics are reserved for severe distress or risk after non-drug measures. Quiet delirium is associated with poor outcomes and should not be dismissed.

Reference: NICE CG103 delirium; NICE CG124 hip fracture