Delirium; a source of confusion in the ED

Author: Freyia Mahon-Daly / Editor: Mark Winstanley, Steve Corry-Bass / Reviewer: Rafeeq Ahmed Sulaiman / Codes: / Published: 19/11/2022

Mrs Jones, an 84-year-old lady is brought into the Emergency Department (ED). She is unaccompanied as she lives in a nursing home which is currently understaffed, meaning no one can accompany her to hospital.

The paramedics explain that her carers report that she has ‘not been herself’ for the past 2 days. A few hours ago she was found to have a fever and the nursing home staff thought that she was coughing more than usual, and bringing up some yellow-green sputum.

Her file from the nursing home shows a list of medications and a summary of her GP records.

Medical history:

  • Type 2 Diabetes mellitus diagnosed aged 62
  • Osteoporosis diagnosed aged 76 following a neck of femur fracture
  • Recurrent urinary tract infections
  • Dementia (Alzheimers disease) diagnosed aged 81


  • Metformin 500mg bd
  • Calcichew 500mg od
  • Alendronic acid 10mg od

She is profoundly confused and repeatedly asks who the staff are and where she is. The nurse-in-charge asks you to assess Mrs Jones. ‘She seems rather delirious to me’, they suggest on their way out of the cubicle.

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