Haloperidol is a very poor treatment for urinary retention. When a person looks agitated, systematically check for direct causes of distress. #delirium

"End of life care for dementia is different to care for other terminal conditions. People with dementia aren't always able to express what's troubling them – that could be pain, anxiety, fear." — Marie Curie Charity

Questions to help to see if a person with #delirium may have delusions: "Do you feel that everyone is treating you well? Do you feel safe here?" #MedEd

“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

Why are we building complex AI systems to detect delirium from casenotes when we could just... do a 2-minute bedside test? The 4AT exists. It's well-validated (33 studies). It's free. Sometimes clinical medicine doesn't need machine learning. #delirium

Direct yet gentle questioning on hallucinations for people with #delirium:  "Have you noticed anything odd recently, like seeing unusual or unexpected things?"

"Identifying the presence of cognitive impairment early is essential to manage the safety and quality risks, reduce harm and improve the healthcare outcomes for older patients during and after a hospital stay." — Australian Commission on Safety and Quality in Health Care

"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

🧠 Delirium is the only dedicated delirium journals 👍100% open access. 👍Ultra-low fees ($20 submission, $280 publication). 👍All study types welcome & rapid 4-week peer review. #delirium

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

Clinical tip on #delirium: with agitation, de-escalate with a calm manner & express empathy, e.g. by saying, "You look worried - how can I help?"

"At every jolt he again felt unendurable pain; his feverishness increased and he grew delirious." - Leo Tolstoy, War and Peace #delirium

Families: Caring for someone with #delirium is exhausting. Your wellbeing matters too. Take breaks, seek support, ask for help.

Family: "I've known him 60 years. This is not him." Chart: "Confused." One of these is clinical data. One is lay description masquerading as a diagnosis. → Calling delirium "confusion" is poor practice ← #delirium

A delirium tool that also finds dementia? New study: n=75,221 older adult admissions ↳ 4AT score ≥1: • 87% sensitive for clinical dementia diagnosis ↳ The 4AT isn't just for delirium anymore. #Delirium #Dementia #4Ms Penfold et al, Age Ageing 2025

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

Clinical tip on #delirium: 'Hyperactive' delirium is when a person is agitated and restless. 'Hypoactive' is when they are sleepy and withdrawn. Some patients fluctuate between these two states.

Myth: Only people with dementia get delirium. Fact: While dementia increases risk, anyone can develop delirium. In hospitals, about 60% of people with #delirium also have dementia.

🙁 "Nobody told me or my family about delirium during my whole time in the hospital. Not the doctors, nurses, support workers - no one mentioned it." -- Delirium survivor ⭐ Communication with patients & families about the diagnosis of delirium is ESSENTIAL for good care. #delirium

Delirium isn't always preventable. But this cascade? Early recognition likely changes the trajectory. #delirium

Do you say "acute confusion" or "acutely confused" instead of delirium? If so, why?

🧠 Delirium = the only dedicated delirium journals. 👍100% open access. 👍Ultra-low fees ($20 submission, $280 publication). 👍All study types welcome & rapid 4-week peer review. #delirium #medtwitter

Emergency Department (ED) staff: screen ALL patients over 65 for delirium. Emergency departments are where it's most missed and most dangerous. Make it as routine as checking blood pressure.

When a person in hospital is restless then it often means they are experiencing #delirium. → Look carefully at their facial expressions - see if they might be seeing things that are not real. → Sometimes asking them - "are you seeing anything strange or frightening?" can help.

Hypoactive #delirium is often missed. It can be mistaken for simple sleepiness, or glossed over as "old age." Look for unexplained inattention, withdrawal, slow responses, limited speech.

The Nursing Delirium Screening Scale (NuDESC). Designed for inpatient monitoring for new #delirium.

The 1977 Royal College of Physicians Working Party on medical care of older people made some telling recommendations still relevant today: 'Geriatrics should be part of undergraduate and postgraduate training for every doctor...'

“My brain was the enemy; it told me the nurses were killers.” — Delirium survivor Psychological care of delirium starts with reality anchoring: “You’re safe, you’re in hospital, I’m your nurse.”

"They come at night with needles. They whisper about you. The machines beep codes. You're not a patient - you're a subject. No one believes you." How do you cope when you're certain the doctors are experimenting on you? #delirium

Missed #delirium = longer stays, more complications, higher mortality, massive costs. But hey, at least we saved 2 minutes by not doing a 4AT in the ED.

More than 1 in 3 older inpatients in this study were dehydrated. Dehydrated patients: 13% higher odds of falling (OR 1.13, P=.002). ↳ Dehydration is cheap to fix - but easy to miss. 💧💧💧💧💧💧💧💧 ⇉ Do you check fluid status on every ward round?

🧠 Delirium is the only dedicated delirium journals 👍100% open access. 👍Ultra-low fees ($20 submission, $280 publication). 👍All study types welcome & rapid 4-week peer review. #delirium

When a patient with #delirium is restless or agitated, use a systematic approach to look for potential causes.

"The ICU nurses played recordings of my voice for my dad. My actual voice. Telling him who I was, where he was, that we loved him. They said it calmed him when nothing else worked." - Daughter #delirium

“When in acute fevers ... the hands are waved before the face, hunting through empty space, as if gathering bits of straw, picking the nap from the coverlet, or tearing chaff from the wall - 𝐚𝐥𝐥 𝐬𝐮𝐜𝐡 𝐬𝐲𝐦𝐩𝐭𝐨𝐦𝐬 𝐚𝐫𝐞 𝐛𝐚𝐝 𝐚𝐧𝐝 𝐝𝐞𝐚𝐝𝐥𝐲.” Hippocrates on #delirium.

"I was so afraid, so afraid, and I cried and shouted…. I was certainly very afraid… I was convinced that they were going to kill me." #Delirium

Day team handover: "Bed 4 is a bit muddled." Night team discovery: patient trying to leave via the window, convinced staff are poisoning them, BP 88/57, sats 91%, obv pneumonia. "Muddled" doing a lot of heavy lifting there. #delirium

"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

For clinicians working with delirium, Fuseli's painting 'The Nightmare' resonates on multiple levels. The patient's vulnerable position, the intrusion of terrifying figures into what should be a safe space, and the sense of helplessness all reflect common elements of the experience of #delirium.

Delirium treatment should involve *brain care* AND *mind care*. #delirium

Shocking reality: 1 in 4 older hospital patients develop #delirium, yet most families have never heard the word. We need to do much better in improving public awareness of delirium.

"We watched our father become someone else. He was convinced we were strangers. He tried to leave at 3am 'to get home' - he was home." - Family member Delirium affects families profoundly. Supporting them is part of treating delirium.

Let's look at delirium and dementia: Episodes of delirium: more rapid progression of dementia. Delirium survivors: x3-fold higher risk of future dementia. ➡️ We really need the support of dementia charities in helping improve delirium care. #delirium #dementia #medtwitter

Delirium has a visibility problem, not just a diagnostic one. How many cases of delirium are you missing day to day by not looking proactively?

🧠 Delirium = the only dedicated delirium journals. 👍100% open access. 👍Ultra-low fees ($20 submission, $280 publication). 👍All study types welcome & rapid 4-week peer review. #delirium #medtwitter

Family members: You are the expert on your loved one's baseline. If staff say "just having a bad day," respectfully insist: "This is not normal for them. I need a delirium assessment."

This image captures what many patients actually experience. Delusions - false beliefs that feel completely real - affect up to 1 in 3 older hospital patients with delirium. A gentle question that can help: "Can you tell me where you think you are right now?" #Delirium

Families know the patient best. "This isn't like her normal self" is very commonly the first sign of #delirium. Staff: take this observation seriously & assess immediately for delirium with a tool like the 4AT.

#Delirium: a history - infographic Find this and other infographics at www.deliriumday.com

"It is essential that all healthcare professionals have the knowledge and skills to provide high-quality, person-centred care to people with dementia." — Alzheimer Society of Canada