Who is at higher risk and what can trigger delirium

NICE identifies higher risk in people aged 65 or older, those with cognitive impairment or dementia, and anyone with a current hip fracture or a severe illness. Staff should watch for any changes in these risk factors whenever they have contact with the person.

NHS and HSC guidance note that delirium often has multiple triggers. Infection is common but not the only cause. Pain, dehydration or poor oral intake, constipation, injury and medicines - including recent changes or missed doses - can all contribute.

Common frontline triggers to think about

• Acute illness or infection: a chest infection, urine infection or another acute illness may be the underlying cause.
• Pain: especially when the person cannot describe it clearly.
• Dehydration or poor intake: reduced drinking or eating can lead to rapid deterioration.
• Constipation: discomfort, straining or abdominal pain may trigger or worsen confusion.
• Medicine effects or recent changes: new medicines, missed doses or side effects may be involved.
• Recent fall, injury, surgery or transfer: these events raise the risk of pain, infection or sudden decline.
• Sensory problems: missing glasses or hearing aids can increase disorientation and distress.

Delirium often has several triggers. Do not lock onto one cause before the person has been properly assessed.