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Review
. 2025 May;43(2):249-263.
doi: 10.1016/j.emc.2024.08.007. Epub 2025 Feb 14.

Delirium Prevention and Management in Older Adults in the Emergency Department

Rachel M Skains  1 , Sangil Lee  2 , Jin H Han  3
Affiliations
Review

Delirium Prevention and Management in Older Adults in the Emergency Department

Rachel M Skains et al. Emerg Med Clin North Am. 2025 May.

Abstract

Delirium, acute brain dysfunction, is present in 10% to 35% of older adults in the emergency department (ED) but unrecognized in ∼80% of cases leading to significant adverse outcomes. Thus, routine screening for delirium is vital to improve prevention and management in the ED. The treatment of delirium focuses on addressing the underlying cause. For agitation, nonpharmacologic measures using the Tolerate, Anticipate, and Don't Agitate (TADA) approach and the Assess, Diagnose, Evaluate, Prevent, and Treat (ADEPT) tool are prioritized for management. If unsuccessful, only the lowest effective dose of pharmacologic agents (atypical antipsychotics) should be used for severe symptom control.

Keywords: Delirium; Emergency department; Geriatrics; Intervention; Management; Prevention.

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Conflict of interest statement

Disclosure R.M. Skains is supported by research grants from the National Institute on Aging, United States (NIA) (R33AG058926, R03AG082923, and R21AG084218) and SAEMF/EMF (GEM2023-0000000008). S. Lee is supported by research grants from the Health Resources and Services Administration, United States (No. 2 U1QHP287310400); S. Lee serves the editorial board for delirium and delirium communications. R.M. Skains and S. Lee received honorarium from West Health Institute and John A. Hartford Foundation for their work on updating Geriatric ED Guidelines 2.0. J.H. Han is supported by research funding from the NIA, United States (R01AG065249, R01AG076998), National Heart, Lung, and Blood Institute, United States (R01HL153607), Center for Disease Control and Prevention (75D30122C14944), PCORI, United States and Merck, United States.

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