Table 4

Approach to the confused elderly patient in hospital (after Inouye3 )

1. Comprehensive history and physical examination, including cognitive testing
2. Review medications: stop all psychoactive medications (or substitute less toxic alternatives); check side effects of all medications
3. Blood tests: blood count, blood urea, electrolytes, calcium, liver function tests
4. Search for occult infection: urinalysis, chestx ray, blood cultures
5. When no obvious cause revealed by the above tests, consider further investigations in selected patients:
  Laboratory tests: magnesium, thyroid function tests, B12, drug screen, toxicology screen, ammonia
  Arterial blood gases: in patients with breathing difficulties, chronic lung disease, suspected venous thrombosis, etc
  Electrocardiogram: in patients with chest pain, shortness of breath or cardiac history
  Cerebrospinal fluid examination: in febrile patients where meningitis is suspected
  CT or MRI scan: in patients with new focal neurological signs, or history or signs of head trauma
  Electroencephalogram: useful in diagnosing occult seizure disorder and differentiating delirium from functional psychiatric disorders
  • CT, computed tomography; MRI, magnetic resonance imaging.