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Delirium in an older inpatient — RACP Adult Medicine MCQ

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ModerateGeriatricsDelirium in an older inpatientRACP Adult Medicine

An 86-year-old woman becomes acutely confused 2 days after hip fracture repair. She is disoriented, inattentive and hallucinating at night. Oxygen saturation is 91%, she has urinary retention and has received oxycodone regularly. What is the most appropriate management?

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Correct answer: C — Identify and treat precipitants with multicomponent non-pharmacological delirium care

Delirium is acute inattention and fluctuating cognition; management focuses on triggers such as hypoxia, urinary retention and opioids, plus orientation, mobilisation, hydration and sensory aids. Antipsychotics are reserved for severe distress or risk after causes are addressed. Restraints, premature dementia labelling and benzodiazepines often worsen delirium.

Reference: Australian Commission on Safety and Quality in Health Care Delirium Standard; AMH