Skip to main content
    • Aa
    • Aa

Delirium in care homes

  • Najma Siddiqi (a1), Andrew Clegg (a2) and John Young (a2)

Delirium is a distressing but preventable condition associated with increased morbidity and mortality, and significant financial costs. Most research on delirium has focused on high-risk patients in hospitals. Another group also at high risk are residents in care homes for older people. This report reviews the literature on the occurrence, aetiology, outcomes, prevention and treatment of delirium in long-term care. Delirium appears to be common in this setting, with a median point prevalence estimate of 14.2% in studies comparable to the UK. However, there is a paucity of high-quality studies, likely to reflect the difficulty in conducting research in this population and the particular challenges of investigating delirium. Addressing delirium successfully in care homes presents an opportunity to improve care standards and to reduce inequalities in health and social care. Well-designed prospective cohort studies and robust evaluations of interventions to prevent and treat delirium are needed.

Corresponding author
Address for correspondence: Dr Najma Siddiqi, Meridian House, Bradford Road, Keighley BD21 4AD. Email:
Hide All
1Inouye SK. Delirium in older persons. N Engl J Med 2006; 354: 1157–65.
2Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med 2008; 168: 2732.
3Inouye SK. Delirium in hospitalized older patients: recognition and risk factors. J Geriatr Psychiatry Neurol 1998; 11: 118–25; discussion 57–8.
4Wittenberg R. Demand for long-term care for older people in England to 2031. National Statistics Quarterly 2001; 12: 516.
5Cacchione PZ, Cacchione PZ. Four acute confusion assessment instruments: reliability and validity for use in long-term care facilities. J Gerontol Nursing 2002; 28: 1219.
6Bowman C, Whistler J, Ellerby M. A national census of care home residents. Age Ageing 2004; 33: 561–6.
7Cunha UG, Faria AC, de F Alves VX, Rigueirinho SA. Hypocortisolemia and delirium in an older patient. J Am Geriatr Soc 2001; 49: 688–9.
8Levkoff SE, Evans DA, Liptzin B, Cleary PD, Lipsitz LA, Wetle TT et al. Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992; 152: 334–40.
9Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc 2000; 48: 618–24.
10Wagner C, Van Der Wal G, Groenewegen PP, de Bakker DH. The effectiveness of quality systems in nursing homes: a review. Quality in Health Care 2001; 10: 211–17.
11Ames D. Nursing homes. Psychiatry 2005; 4: 7982.
12American Psychiatric Association. Task Force on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, 3rd edn.Washington, DC: American Psychiatric Association, 1980.
13American Psychiatric Association. Work Group to Revise DSM-III. Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R, 3rd edn.Washington, DC: American Psychiatric Association, 1987.
14American Psychiatric Association. Task Force on DSM-IV. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th edn.Washington, DC: American Psychiatric Association, 1994.
15World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992.
16Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. The impact of different diagnostic criteria on prevalence rates for delirium. Dement Geriatr Cogn Disord 2003; 16: 156–62.
17Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113: 941–48.
18Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res 1988; 23: 8997.
19Mentes J, Culp K, Maas M, Rantz M. Acute confusion indicators: risk factors and prevalence using MDS data. Res Nurs Health 1999; 22: 95105.
20Godfrey M, Denby T. The methodology of systematic reviews. Available at: (accessed 23 Dec 2009).
21Wells GA, Shea B, O'Connell D, J Peterson, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. Available at: (accessed 23 Dec 2009).
22Sandberg O, Gustafson Y, Brannstrom B, Bucht G. Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly. Scand J Soc Med 1998; 26: 5662.
23Pitkala KH, Laurila JV, Strandberg TE, Tilvis RS. Prognostic significance of delirium in frail older people. Dement Geriatr Cogn Disord 2005; 19: 158–63.
24Rovner BW, German PS, Broadhead J, Morriss RK, Brant LJ, Blaustein J et al. The prevalence and management of dementia and other psychiatric disorders in nursing homes. Int Psychogeriatr 1990; 2: 1324.
25Cacchione PZ. Four acute confusion assessment instruments: reliability and validity for use in long-term care facilities. J Gerontol Nurs 2002; 28: 1219.
26Cacchione PZ, Culp K, Dyck MJ, Laing J. Risk for acute confusion in sensory-impaired, rural, long-term-care elders. Clin Nurs Res 2003; 12: 340–55.
27Fries BE, Mehr DR, Schneider D, Foley WJ, Burke R. Mental dysfunction and resource use in nursing homes. Med Care 1993; 31: 898920.
28Dosa D, Intrator O, McNicoll L, Cang Y, Teno J. Preliminary derivation of a Nursing Home Confusion Assessment Method based on data from the Minimum Data Set. J Am Geriatr Soc 2007; 55: 1099–105.
29Andrew MK, Freter SH, Rockwood K. Prevalence and outcomes of delirium in community and non-acute care settings in people without dementia: a report from the Canadian Study of Health and Aging. BMC Med 2006; 4: article 15 (Epub).
30Fick DM, Kolanowski AM, Waller JL, Inouye SK. Delirium superimposed on dementia in a community-dwelling managed care population: a 3-year retrospective study of occurrence, costs, and utilization. J Gerontol A Biol Sci Med Sci 2005; 60: 748–53.
31Culp K, Tripp-Reimer T, Wadle K, Wakefield B, Akins J, Mobily P et al. Screening for acute confusion in elderly long-term care residents. J Neurosci Nurs 1997; 29: 86–8, 95–100.
32Kiely DK, Bergmann MA, Murphy KM, Jones RN, Orav EJ, Marcantonio ER. Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. J Gerontol A Biol Sci Med Sci 2003; 58: M44145.
33Marcantonio ER, Simon SE, Bergmann MA, Jones RN, Murphy KM, Morris JN. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. J Am Geriatr Soc 2003; 51: 49.
34Kelly KG, Zisselman M, Cutillo-Schmitter T, Reichard R, Payne D, Denman SJ. Severity and course of delirium in medically hospitalized nursing facility residents. Am J Geriatr Psychiatry 2001; 9: 7277.
35Cacchione PZ, Culp K, Laing J, Tripp-Reimer T. Clinical profile of acute confusion in the long-term care setting. Clin Nurs Res 2003; 12: 145–58.
36Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Impact of different diagnostic criteria on prognosis of delirium: a prospective study. Dement Geriatr Cogn Disord 2004; 18: 240–44.
37Marcantonio ER, Kiely DK, Simon SE, John Orav E, Jones RN, Murphy KM et al. Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc 2005; 53: 963–69.
38Bergmann MA, Murphy KM, Kiely DK, Jones RN, Marcantonio ER. A model for management of delirious postacute care patients. J Am Geriatr Soc 2005; 53: 1817–25.
39Mentes JC, Culp K. Reducing hydration-linked events in nursing home residents. Clin Nurs Res 2003; 12: 210–25; discussion 26–28.
40Culp K, Mentes J, Wakefield B. Hydration and acute confusion in long-term care residents. West J Nurs Res 2003; 25: 251–66; discussion 67–73.
41Siddiqi N, Young J, Cheater FM, Harding RA. Educating staff working in long-term care about delirium: the Trojan horse for improving quality of care? J Psychosom Res 2008; 65: 261–66.
42Zermansky AG. Including care home residents in clinical research is fraught. BMJ 2005; 331: 1271–72.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Reviews in Clinical Gerontology
  • ISSN: 0959-2598
  • EISSN: 1469-9036
  • URL: /core/journals/reviews-in-clinical-gerontology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 15 *
Loading metrics...

Abstract views

Total abstract views: 182 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd October 2017. This data will be updated every 24 hours.