Delirium in geriatric emergency medicine requires a structured, evidence-based approach to risk stratification, diagnosis, and imaging. While delirium affects up to 38% of older emergency department patients, it remains frequently under-recognized, particularly in its hypoactive form. Current clinical guidelines, developed using the GRADE framework, recommend utilizing validated diagnostic tools like the 4AT or the combination of the Delirium Triage Screen and the Brief Confusion Assessment Method (BCAM) rather than relying on clinical gestalt. Although these tools assist in identification, evidence regarding routine head CT scans for undifferentiated delirium remains insufficient, necessitating selective use based on clinical red flags. Effective management extends beyond diagnosis, requiring non-pharmacologic interventions—such as sensory optimization, mobility, and family engagement—to mitigate functional decline and improve patient-oriented outcomes in the emergency setting.
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