Acute Brain Failure in Older Emergency Department Patients

Delirium in older emergency department patients represents a critical medical emergency, better understood as "acute brain failure" to emphasize its urgency and severity. Affecting one in ten patients over 65, this condition correlates with increased mortality, longer hospital stays, and significant long-term cognitive decline. Because clinical gestalt fails to identify delirium in at least half of cases, systematic screening using tools like the Delirium Triage Screen or the Brief Confusion Assessment Method is essential. Effective management requires identifying underlying precipitating insults—such as infections, medication errors, or metabolic disturbances—and implementing non-pharmacological interventions like sensory aids and family presence. When agitation necessitates pharmacological treatment, clinicians must prioritize low-dose atypical antipsychotics, aiming for patient comfort rather than sedation, while carefully avoiding agents contraindicated by underlying conditions like Parkinson’s disease.