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GERICLINICS

Clinical case · Delirium

Sudden confusion two days after hip fracture surgery

An 84-year-old woman becomes agitated at night and drowsy by day after surgery for a hip fracture. Recognise delirium, find the precipitants and manage them.

Beginner 12 minNeeds clinical review

You will learn to

  • Recognise delirium using a structured tool, including hypoactive features
  • Identify predisposing and precipitating factors after surgery
  • Plan multicomponent, non-drug management and know the limited role of antipsychotics

Presentation

Step 1 of 10

You are asked to review an 84-year-old woman on the orthopaedic ward, two days after surgical fixation of a fractured neck of femur.

The night nurse reports that she was calling out for her late husband and pulling at her cannula overnight. This morning she is drowsy and keeps drifting off during conversation. Her daughter says, "This isn't my mother at all."

References

  1. Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941–948. doi:10.7326/0003-4819-113-12-941 · PubMed 2240918
  2. Tieges Z, Maclullich AMJ, Anand A, et al. Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age Ageing. 2021;50(3):733–743. doi:10.1093/ageing/afaa224 · PubMed 33951145
  3. Inouye SK, Bogardus ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669–676. doi:10.1056/NEJM199903043400901 · PubMed 10053175
  4. Neufeld KJ, Yue J, Robinson TN, Inouye SK, Needham DM. Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2016;64(4):705–714. doi:10.1111/jgs.14076 · PubMed 27004732
  5. Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med. 2017;377(15):1456–1466. doi:10.1056/NEJMcp1605501 · PubMed 29020579
  6. The 4AT — rapid clinical test for delirium. link

Last updated 2026-10-06.

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