A foundation doctor's guide to clerking the confused older patient

Confusion is a common cause of acute admissions, encompassing dementia, delirium and depression (Bostwick, 2000). Because of this diagnostic challenge, acute confusion is often misdiagnosed and undertreated; one study found this to be the case in 94% of older people in hospitals (Ski and O'Connell, 2006). For a foundation doctor it can be difficult to know where to start with such a patient and yet this type of admission is extremely common. This article raises awareness of the appropriate management of a patient with confusion as part of good medical practice and thus improve the quality of care for patients with dementia and delirium in hospitals.