Treatment of delirium in old age

Delirium in old age is a frequent and devastating complication of internal and surgical disease. Although preventable, it has a significant economical impact. On the basis of age, multi-morbidity and sensory impairment as predisposing factors delirium is induced by infections, dehydration, surgery and centrally-acting anticholinergic medication. Diagnosis is based on DSM-IV or the more rigid ICD10 criteria, supported by screening tests and EEG. Evidence-based delirium management focuses on precipitating factor avoidance and prevention of sequelae. Medication is required when symptoms are threatening as hyperactivity, self harm and anxiety. Haloperidol is recommended. Cholinesterase Inhibitors have been successful, especially in dementia. The prevention of delirium is considered an indicator of quality in health care of the elderly.