Reassurance works best when it is specific and true. Say who you are, where the person is and what will happen next. #delirium

Do not promise a fixed recovery date after delirium. Give an honest range and explain what changes should prompt review. #delirium

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

The patient still has delirium. What should we do today? Five questions for the delirium ward round, with a free checklist in PDF and Word. Read the article and download the checklist: deliriumwords.com/delirium-...

Hogarth's "A Rake's Progress" ends in Bedlam (1735). For centuries, acute confusion meant the madhouse. We now know most sudden confusion in hospital is delirium: usually reversible, often something we caused, and rarely madness at all. #delirium #art

Orientation should be gentle. Say where the person is and why, then offer reassurance rather than testing them repeatedly. #delirium

Some people need help to drink before dehydration develops. Notice difficulty reaching, pouring or remembering the cup. #delirium

A quote from a family member of a patient with delirium: "grieving for someone who's still alive." Caring for loved ones with delirium, especially if it is persistent, can be stressful and exhausting. Professionals should provide support to families as well as patients.

A few years ago delirium barely featured in nursing curricula. Now we're beginning to see it embedded as a core competency. Progress is slow, though, and this is bad for patients as well as nurses. What does delirium training look like at your institution? #nursingeducation

A sudden fall in eating or drinking may accompany delirium. Look for other changes and assess the person rather than treating appetite in isolation. #delirium

Urinary retention can present as distress, agitation or worsening confusion. Consider it when searching for delirium triggers. #delirium

"The scan was normal" is not the same as "the patient is."

Clinicians: if you found delirium, name it. “Acute confusion” should not be where the record ends. Write “delirium” so the episode drives review, is explained to the family and reaches the discharge letter. “Query confusion” protects nobody. AI-generated teaching film. #Delirium #4AT

“This isn’t them.” Families often spot delirium first. A change over hours, with fluctuating agitation, drowsiness, or confusion, needs urgent assessment. Delirium is different from dementia, though they often coexist. #Delirium #PatientSafety

Delirium education needs to address understanding the basics, fundamental actions, and the issue of attitudes to delirium, as well as ownership. #delirium #education

A positive delirium screen is not success. Success is a closed loop: clinical assessment, cause-focused care, family involvement, daily review, safe transitions and recovery support, with named ownership and feedback when the pathway fails. #delirium #clinicalhonesty

❓Can delirium assessment work at scale in routine care? 💡 A Scotland-wide study of more than 18,000 people presenting with hip fracture found that 91% received a 4AT assessment. 1 in 5 were positive for delirium. Link below. #delirium #4AT

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

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."

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