Delirium and Dementia in Hospitalized Older Adults: Differential Diagnosis, Screening, Management, Rehabilitation and Quality of Care
DOI:
https://doi.org/10.12775/QS.2026.64.73576Keywords
Delirium, Dementia, Older Adults, Hospitalization, Differential Diagnosis, Screening, Quality of Care, RehabilitationAbstract
Introduction: Delirium and dementia are among the most common neurocognitive disorders in hospitalized older adults. As populations age, both conditions are becoming a major challenge for healthcare systems. Recent evidence suggests that their relationship is more complex than previously thought, with important implications for diagnosis, prevention, and long-term outcomes.
Purpose of Research: This review summarizes current knowledge on the relationship between delirium and dementia in older adults, with emphasis on risk factors, diagnostic difficulties, prevention, treatment, rehabilitation, and long-term cognitive consequences.
Material and methods: A literature review was conducted using publications identified in Google Scholar, PubMed, and Embase. The selected studies focused on delirium and dementia in hospitalized older adults, including epidemiology, diagnosis, prevention, management, and cognitive outcomes.
State of knowledge: Delirium remains one of the most common complications of hospitalization in older adults and is still underrecognized, especially in patients with pre-existing dementia. Distinguishing acute delirium from chronic cognitive decline is difficult but essential. Current evidence shows that delirium is associated with longer hospitalization, functional decline, and worse long-term cognitive outcomes. Multicomponent non-pharmacological interventions, such as orientation support, early mobilization, hydration and nutrition optimization, and medication review, appear to be the most effective preventive strategy. More attention is also being paid to rehabilitation and follow-up after discharge.
Conclusions: Delirium and dementia are closely interconnected and often coexist in hospitalized older adults. Early recognition, prevention, multidisciplinary management, rehabilitation, and appropriate follow-up are essential to improve outcomes and preserve cognitive function.
References
1. Wan, M., & Chase, J. M. (2017). Delirium in older adults: Diagnosis, prevention, and treatment. British Columbia Medical Journal, 59(3), 165-170.
2. Jaqua, E. E., & Chin, E. (2023). Delirium in older persons: prevention, evaluation, and management. American Family Physician, 108(3), 278-287.
3. Jandu, J. S., Mohanaselvan, A., & Fang, X. (2025). Differentiating Delirium Versus Dementia in Older Adults. In StatPearls [Internet]. StatPearls Publishing.
4. Grover, S., & Avasthi, A. (2018). Clinical practice guidelines for management of delirium in elderly. Indian Journal of Psychiatry, 60(Suppl 3), S329-S340.
5. Gordon, E. H., Ward, D. D., Xiong, H., Berkovsky, S., & Hubbard, R. E. (2024). Delirium and incident dementia in hospital patients in New South Wales, Australia: retrospective cohort study. BMJ, 384, e075993.
6. Ospina-Lehmann, A., Castañeda-Gómez, M. C., Pabón-Martínez, E. J., Vigoya-Aponte, J. P., Orozco-Castro, S., Chavarro-Carvajal, D. A., & Cano-Gutiérrez, C. A. (2025). Delirium in elderly hospitalized patients: analyzing clinical and social determinants in a Colombian retrospective cohort. International Journal of Geriatric Psychiatry, 40(4), e70079.
7. Tieges, Z., Maclullich, A. M., Anand, A., Brookes, C., Cassarino, M., O'Connor, M., et al. (2021). Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age and Ageing, 50(3), 733-743.
8. Hshieh, T. T., Yang, T., Gartaganis, S. L., Yue, J., & Inouye, S. K. (2018). Hospital Elder Life Program: systematic review and meta-analysis of effectiveness. The American Journal of Geriatric Psychiatry, 26(10), 1015-1033.
9. Shen, H., Liu, X., Wu, L., Jia, J., & Jin, X. (2024). Effect of Hospital Elder Life Program on the incidence of delirium: a systematic review and meta-analysis of clinical trials. Geriatric Nursing, 56, 225-236.
10. Scheunemann, L. P., Girard, T. D., Skidmore, E. R., & Resnick, N. M. (2018). The Hospital Elder Life Program: past and future. The American Journal of Geriatric Psychiatry, 26(10), 1034-1035.
11. Lepkowsky, C. M. (2025). Recommended additions to the new APA guideline for prevention and treatment of delirium. Medical Research Archives, 13(11).
12. Norfolk and Norwich University Hospitals NHS Foundation Trust. (2020). Acute management of delirium in older patients. Clinical Guideline.
13. Kim, Y. H., Kim, N. Y., & Ryu, S. (2022). Effects of non-pharmacological interventions for preventing delirium in general ward inpatients: a systematic review and meta-analysis of randomized controlled trials. PLoS One, 17(5), e0268024.
14. Al Farsi, R. S., Al Alawi, A. M., Al Huraizi, A. R., Al-Saadi, T., Al-Hamadani, N., Al Zeedy, K., & Al-Maqbali, J. S. (2023). Delirium in medically hospitalized patients: prevalence, recognition and risk factors: a prospective cohort study. Journal of Clinical Medicine, 12(12), 3897.
15. Fong, T. G., & Inouye, S. K. (2022). The inter-relationship between delirium and dementia: the importance of delirium prevention. Nature Reviews Neurology, 18(10), 579-596.
16. Morandi, A., & Bellelli, G. (2020). Delirium superimposed on dementia. European Geriatric Medicine, 11(1), 53-62.
17. Shrestha, P., & Fick, D. M. (2023). Recognition of delirium superimposed on dementia: is there an ideal tool? Geriatrics, 8(1), 22.
18. Morandi, A., Davis, D., Bellelli, G., Arora, R. C., Caplan, G. A., Kamholz, B., et al. (2017). The diagnosis of delirium superimposed on dementia: an emerging challenge. Journal of the American Medical Directors Association, 18(1), 12-18.
19. Whitby, J., Nitchingham, A., Caplan, G., Davis, D., & Tsui, A. (2022). Persistent delirium in older hospital patients: an updated systematic review and meta-analysis. Delirium, 1, 36822.
20. Lu, Z., Wang, X., Wang, J., Zhao, L., Wu, Y., Sun, M., & Zhang, J. (2025). The intersection of delirium and long-term cognition in older adults: the critical role of delirium prevention. Journal of Neurology, 272(6), 381.
21. Hsieh, S., Schubert, S., Hoon, C., Mioshi, E., & Hodges, J. R. (2013). Validation of the Addenbrooke's Cognitive Examination III in frontotemporal dementia and Alzheimer's disease. Dementia and geriatric cognitive disorders, 36(3-4), 242-250.
22. Inouye, S. K., Westendorp, R. G. J., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922.
23. Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K. (2017). Delirium in older persons: advances in diagnosis and treatment. JAMA, 318(12), 1161-1174.
24. Marcantonio, E. R. (2017). Delirium in hospitalized older adults. New England Journal of Medicine, 377(15), 1456-1466.
25. American Geriatrics Society Expert Panel. (2015). Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. Journal of the American College of Surgeons, 220(2), 136-148.
26. National Institute for Health and Care Excellence. (2023). Delirium: prevention, diagnosis and management. NICE Guideline NG103.
27. American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Washington, DC: American Psychiatric Publishing.
28. Bellelli, G., Morandi, A., Davis, D. H. J., Mazzola, P., Turco, R., Gentile, S., et al. (2014). Validation of the 4AT, a new instrument for rapid delirium screening. Age and Ageing, 43(4), 496-502.
29. Alzheimer's Disease International. (2024). World Alzheimer Report 2024. London: Alzheimer's Disease International.
30. Inouye, S. K. (2023). The Hospital Elder Life Program (HELP): overview, achievements, and future directions. Clinics in Geriatric Medicine, 39(2), 183-197.
31. Neufeld, K. J., Yue, J., Robinson, T. N., Inouye, S. K., & Needham, D. M. (2016). Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta‐analysis. Journal of the American Geriatrics Society, 64(4), 705-714.
32. Brodaty, H., Pond, D., Kemp, N. M., Luscombe, G., Harding, L., Berman, K., & Huppert, F. A. (2002). The GPCOG: a new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 50(3), 530-534.
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Copyright (c) 2026 Magdalena Mąka, Julia Woźniak, Sabina Kadłubek, Natalia Kapturska, Piotr Kardaszewski, Kinga Cymerys, Szymon Kalinowski, Dominik Sikora, Jakub Kamiński, Ewa Góralczyk
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