ArticleJournal of general internal medicine2026
Delirium in Older Adults Presenting to the Emergency Department: Prevalence, Risk Factors, Management Strategies, and Hospital Utilization Outcomes.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
Funding
Abstract
backgroundDespite the emergency department (ED) being a primary entry point for acutely ill older adults, delirium in this setting remains poorly characterized. This study aimed to determine ED delirium prevalence, identify associated patient characteristics in a diverse population, describe current ED management practices, and examine hospital utilization outcomes in a large, heterogeneous cohort.
methodsThis multi-site retrospective cohort study analyzed 2,827 older adult patients (≥ 65 years) across three diverse EDs within a single integrated health system in the New York metropolitan area, identifying delirium via rigorous, validated in-depth chart review requiring evidence of acute change from baseline. Independent risk factors for ED delirium and hospital admission were identified via modified Poisson regression. Management strategies and 30-day hospital utilization outcomes were characterized. All analyses were stratified by control and intervention periods of a parent delirium screening trial.
resultsED delirium prevalence was 16.0% (95% confidence interval: 14.6-17.4%), consistent across study periods and sites. The prevalence of delirium was 27.3% among hospitalized patients; 7.9% of all discharged patients had delirium. Independent risk factors included advanced age (adjusted relative risk, aRR = 1.01), dementia (aRR = 3.10), higher Charlson Comorbidity Index (aRR = 1.06), facility arrival (aRR = 1.28), and higher ED acuity (aRR = 3.85 for highest). Patients with delirium were more likely to receive physical restraints, psychoactive medications, and constant observation, but also safety precautions, family involvement, and palliative care consults (all p < 0.001). Delirium independently predicted hospital admission (aRR = 1.54) and was associated with higher 30-day readmissions (19% vs. 13%; p = 0.002).
conclusionsApproximately 1 in 6 older ED patients had delirium, including 7.9% who were discharged home. ED management involved both restrictive (restraints, psychoactive medications) and supportive (Goals-of-Care discussions, family involvement, safety precautions) strategies, though the latter remained underutilized. These findings underscore the critical need for standardized delirium screening, enhanced recognition, and supportive strategies.
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