@confuseddoc

Consultant Geriatrician with speciality interests in Community and Interface Geriatrics. All views are mine

 Leicester, England
Joined February 2016
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60Media
❗️NHS ENGLAND POLICY ↳ "Patients aged over 65 presenting to hospital as an emergency should be assessed by a competent clinical decision-maker within 30 minutes of arrival using the Clinical Frailty Scale (CFS) & the 4AT tool for delirium." #delirium #MedTwitter #frailty
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This 2005 study by Andrew, Freter & Rockwood was one of the first to show that when doctors didn't recognise delirium, outcomes were significantly worse. 68% of patients had poor outcomes at 6 months. But the most striking finding: poor recognition by the treating team was associated with 18x higher odds of death or functional decline. Twenty years on, under-recognition remains the single most fixable problem in delirium care. Are we any better at it now? #delirium #geriatrics
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Chris Miller retweeted
Tom Hutchinson@geriatricgiantFeb 5
Frailty musing: (unfortunately) in present systems, once you realise that your frail patient has a 50:50 chance of improving vs worsening in acute care - you can start discharging many more patients
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When screening rates hit 91% completion across an entire country's hip fracture population & people still try to tell you delirium screening can't be done at scale. 18,040 patients 🙌 The evidence has entered the building.
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⭐ New delirium resource: 50 free clinical cases to practice 4AT #delirium scoring 12 healthcare settings. 3 difficulty levels. Read the case, note your score, then click 'Show Worked Solution'. No login. No ads. Just learning. Please RT & share with colleagues! Link 👇
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"You can't properly assess for delirium when someone already has dementia." Wrong. New meta-analysis (Keane et al. 2026): 4AT shows 88% sensitivity, 79% specificity in dementia populations. 5 studies. 1,304 patients. International data. #delirium #dementia
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Have you ever wondered about the components of the 4AT delirium assessment tool? This video of <3 mins walks through each element of the 4AT. Also available on YouTube - link below. --> If useful, please share with colleagues who screen for delirium. #delirium
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Chris Miller retweeted
JAGS@AGSJournalJan 22
When Delirium Unmasks a Silent Myocardial Infarction. #geriatrics agsjournals.onlinelibrary.wi…
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Emergency Department (ED) staff: screen ALL patients over 65 for delirium. Emergency departments are where it's most missed and most dangerous. Make it as routine as checking blood pressure.
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Emergency Department (ED) staff: screen ALL patients over 65 for delirium. Emergency departments are where it's most missed and most dangerous. Make it as routine as checking blood pressure.
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Older person confused. Urine dipped. 'Positive'. Antibiotics. Feeling of "job done." Except: delirium missed, true causes not found, patient discharged still confused. 🫥🫥🫥 ➡️ New confusion = delirium. Same attention needed as chest pain or acute kidney injury. 👍👍👍
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Emergency Department (ED) staff: screen ALL patients over 65 for delirium. Emergency departments are where it's most missed and most dangerous. Make it as routine as checking blood pressure.
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Our Integrated Systems resources are here to support you in creating frailty and age-attuned systems. These include top tips, template job descriptions, video conversations, and blogs. So, steal with pride, and take advantage of what others have learned. buff.ly/egxd25N
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To support prescribing decisions for older people with moderate to severe frailty, we recently published our Pragmatic Prescribing guidance. Endorsed by the @rpharms, the @rcgp, @RCPEdin, and the @RCPhysicians, this document was an instant hit. buff.ly/n33nYtM
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Interface roles are becoming more common across the country, with more consultant geriatricians working across community and acute settings. Our Integrated Systems resource has a top tips page for recruiting to Interface Consultant posts. buff.ly/GbOwsqo
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All these informal terms - avoiding saying "delirium" - makes care FAR less effective. Use #DELIRIUM.
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In May, we celebrated our inaugural #ChooseGeriatrics week, during which we shared blogs and videos from people across the MDT celebrating their choice to work in older people’s healthcare. Read our blogs here: buff.ly/gA2LTjM
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On the second day of BGS… In August, we co-produced the report “Hospital at home for frailty” with @UKHaHSoc. Hospital at Home, also referred to as virtual wards, enables people to remain at home while receiving the diagnosis and treatment they need. buff.ly/XU6WI2X
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Welcome to the 1st day of BGS! Over the next 12 days, we'll be celebrating our highlights of 2025. July saw the launch of a brand new BGS resource hub on Comprehensive Geriatric Assessment. CGA is the cornerstone of good quality care for older people. buff.ly/E16MLYD
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🧠⚕️ Treating delirium is complex. ♥️ But always remember that there is a person in front of you who is suffering & needs warmth, gentleness & skilled interaction. 🪢 Thinking about delirium treatment as both brain care & mind care is essential. #delirium #acutecare
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