Géricault, "The Raft of the Medusa" (1819). The survivors drifted 13 days: thirst, starvation, and delirium driving some to hallucination and violence. Painted as scandal and history, it is also a study of what the brain does when the body is pushed past its limits. #delirium #art

Reversed day and night is one of the earliest signs of delirium. Dozing all afternoon, awake and muddled at 3am: a broken sleep-wake cycle is one of the earliest signs the brain is in trouble. Notice it on night one. #delirium

Delirium on top of dementia is the commonest kind and the easiest to miss. A sudden worsening in someone with dementia is not "just their dementia". A step change over hours or days is delirium until proven otherwise. Know the baseline. #delirium

Thirst is an unreliable alarm in old age. The sensation blunts, so an older person can be genuinely dry and never feel it. Offer fluids, do not wait to be asked, and put the drink in the hand, not on the far table. #geriatrics

"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

We measure temperature four times a day and attention never.

Study spotlight: UK Biobank matched cohort (Haapanen et al., Age & Ageing 2026). Delirium raised nursing home admission and brought it forward ~1.3-1.6 years, even without dementia. Prevention protects independence. #delirium

For delirium researchers: Publishing delirium research should not require a four-figure fee. Delirium is open access: €20 to submit and a €280 APC on acceptance. Peer review is estimated to take 4–6 weeks under normal circumstances. deliriumjournal.com/for-aut... #Delirium

For Authors | Delirium

The open-access home for delirium research, quality improvement, reviews, protocols, and case reports.

deliriumjournal.com

Antipsychotics do not treat delirium. They do not shorten it, prevent it, or fix the cause, and they carry real risks in older people. Find the cause first. Keep the drug for the rare moment nothing else keeps someone safe. #delirium

"For after I saw him fumble with the sheets, and play with flowers, and smile upon his fingers' ends... and 'a babbled of green fields.'" Shakespeare, Henry V: Mistress Quickly describing Falstaff's death. Four centuries on, still one of the most exact deliriums in all of literature. #delirium

The first time an adult child sees a parent delirious, something shifts. The steady figure who raised you is frightened, lost, and does not always know you. It is grief for someone still alive. Warn families, and reassure them it usually passes. #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

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

Bosch, "Cutting the Stone", c. 1500: a quack removes the "stone of madness". One operation, sanity restored. The fantasy survives: one scan, one pill. Delirium care has no stone. It is many small things done well. #delirium #art

Hand over the baseline, not just the numbers. The vital handover in delirium is the story: this is delirium not dementia, this is her normal, this is the cause, this is the plan. Without it the next team starts from zero. #delirium

A casual record of 'new confusion' or worse, just 'confusion', is imprecise and prevents clear treatment and communication. It's lazy and harmful. Be professional. Upgrade. Use the right technical term: delirium. #delirium #encephalopathy

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?

Publishing delirium research should not require a four-figure fee. Delirium is open access: €20 to submit and a €280 APC on acceptance. Peer review is estimated to take 4–6 weeks under normal circumstances. deliriumjournal.com/for-aut... #Delirium

For Authors | Delirium

The open-access home for delirium research, quality improvement, reviews, protocols, and case reports.

deliriumjournal.com

We consent older surgical patients for bleeding, infection and clots, and skip the complication they are most likely to meet: delirium. Name it beforehand. What it is, that it typically lifts within days, how families can help. #periop #delirium

"I see her, she’s talking to me, she’s alive!" (Hallucinating under medication) Taxi Driver, Martin Scorcese

Delirium screening is a repeated measure, not a single reading. Lucid at ten, inattentive by eight: fluctuation is the fingerprint. One normal check does not clear it. Ask the night staff and check again. #delirium

Who should be screened for delirium? More people than we screen: everyone 65+ admitted acutely, anyone with dementia or prior delirium, after major surgery, the acutely unwell, the sensory-impaired. Screen by risk, not by noise. #delirium

"Dementia is a disability. People with #dementia have the right to be treated with dignity and respect, and to receive the care and support they need to live well." Source: Alzheimer's Disease International (ADI)

Mrs Smith, 78, hip fracture patient, described as "confused & aggressive" Ward round note: "?UTI. Start antibiotics." No mention of "delirium" My reaction: What about her distress - untreated pain? Dehydration? Medication review? Telling the family the diagnosis? Etc. Why we need Delirium 8 👇

For delirium researchers: Publishing delirium research should not require a four-figure fee. Delirium is open access: €20 to submit and a €280 APC on acceptance. Peer review is estimated to take 4–6 weeks under normal circumstances. deliriumjournal.com/for-aut... #Delirium

For Authors | Delirium

The open-access home for delirium research, quality improvement, reviews, protocols, and case reports.

deliriumjournal.com

Older acute patient with confusion. Myth: "I'll do the investigations first, then talk to family." Reality: Talking to family in parallel, or as early as possible, is crucial. It takes 2 minutes and can changes your entire diagnostic approach.

Asclepiades (124-140 BC) defined phrenitis (early term for #delirium) as "a stoppage or obstruction of the corpuscles in the membranes of the brain frequently with no feeling of pain and accompanied by a loss of reason and fevers."

Ask patients what helped in delirium - often it is how they were spoken to and what reassurance was provided. Warmth, friendliness, being told what is happening. Repeated frequently for as long as it takes. This should be built into every interaction in delirium care. #delirium

Noting that a patient is "confused" just isn't enough. Don't assume any cognitive impairment is dementia - it may be delirium. A brief conversation with the family can provide critical information. #Delirium

"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