Published by
WestNet Medical Publications
medical.westnet.ca Co-published with
WestNet Humanitarian Services (WHS)
UN Supplier / NGO • www.westnet.ngo WestNet Catalog 731985456659
ISBN 978-0-XXXXX-XXX-X (Pending)
WestNet Medical • Module 11 • Delirium, Dignity & the Older Adult
WestNet Unified Health Platform • WestNet Catalog 731985456659 • ISBN 978-0-XXXXX-XXX-X (Pending)
CE Accreditation Path: ANCC • ACCME • CARNA
Last updated: June 2026
Core Learning Objective
Learners will distinguish delirium from dementia and depression, screen reliably with the 4AT and CAM, and treat delirium as the medical emergency it is — hunting first for the reversible, often iatrogenic cause (a drug, an infection, dehydration, urinary retention, unrelieved pain) rather than reaching reflexively for a sedative. Throughout, the older adult is restored to dignity, not quieted below baseline.
WestNet Medical
Clinical Education Division • Unified Health Platform
“Delirium is the body shouting that something is wrong — a drug, an infection, a dry mouth, a full bladder, a pain no one asked about. The reflex is to sedate the noise. The discipline is to ask what is causing it. Dementia, too, is far more reducible than we once taught. The older adult in front of you is a whole person with a lifetime of meaning, not a bed number to keep quiet. Our task is to make humans human again.”
Published By
WestNet Medical Publications
A division of WestNet North America Inc. medical.westnet.ca
Co-Published With
WestNet Humanitarian Services (WHS)
UN Supplier • Registered NGO www.westnet.ngo
WestNet Catalog (UPC-A): 7 31985 45665 9
ISBN 978-0-XXXXX-XXX-X (Pending) • First Edition
7 31985 45665 9
WestNet Medical Publications
Continuing Education Information
CE
Field
Detail
Module
11 of 12 — Geriatrics
Contact Hours
5.0 (Pending ANCC / ACCME / CARNA approval)
Target Audience
RNs, LPNs, RPNs, NPs, Geriatric & Med-Surg Nurses, Care Aides, Pharmacists, Social Workers, Licensed Clinicians
Publication
WestNet Medical Publications • Catalog 731985456659 • ISBN Pending
Disclosure
Educational content. Does not replace facility policy, physician orders, prescriber judgement, or jurisdictional requirements.
Differentiate delirium, dementia, and depression using onset, course, attention, and consciousness
Screen for delirium at the bedside using the 4AT and the Confusion Assessment Method (CAM)
Recognize hypoactive delirium — the quiet, frequently missed presentation
Systematically search for reversible and iatrogenic causes of delirium (DELIRIUM mnemonic)
Apply Beers Criteria and the anticholinergic burden concept to reduce harm in older adults
Implement multifactorial fall-prevention and deprescribing as active forms of care
Deliver person-first, dignity-centered geriatric care — and distinguish faith from pathology
Program Preface
§ 01
This module was developed from clinical workflow analysis across North American hospitals, emergency departments, and long-term care — not from textbook theory alone. Older adults are admitted for one thing and harmed by another: an acute confusion that is too often charted as “just dementia” or “sundowning,” sedated, and sent on its way without anyone asking the only question that matters — what is causing this?
Module 11 is not anti-geriatric medicine. It is anti-passive geriatric medicine — the kind that accepts confusion as inevitable in old age, that adds a drug rather than removes one, and that measures a shift’s success by how quiet the unit is rather than by whether the patient is returning to who they were.
WestNet Position
Delirium is a medical emergency with a roughly one-in-three independent mortality signal — yet it is missed in the majority of cases, especially the quiet, hypoactive kind. The first move is never sedation. It is observation: establish the patient’s baseline, then ask what acutely changed.
The Three D’s: Delirium, Dementia, Depression
§ 02
The single most consequential skill in geriatric care is telling these three apart, because they look alike at the bedside and demand opposite responses. Delirium is acute, fluctuating, and inattentive — and it is usually reversible. Dementia is chronic, slowly progressive, and (until late) preserves alertness. Depression can mimic both as “pseudodementia,” with low mood, slowed thought, and “I don’t know” answers. They also coexist: delirium is far more common, and far more dangerous, when superimposed on dementia.
At a glance. The same bedside picture demands opposite responses. Use the quick-reference below to separate the three D’s on the features that actually discriminate — then, for any acute change, run the reversible-cause checklist before anything else. (Differentiation supports, never replaces, full clinical assessment; verify management against current local protocols.)
Feature
Delirium
Dementia
Depression
Onset
Acute (hours–days)
Insidious (months–years)
Subacute (weeks; often datable)
Course
Fluctuates; worse at night
Slowly progressive, stable day to day
Persistent low mood, diurnal variation
Attention
Impaired — the hallmark
Preserved until late
Variable, effort-poor (“don’t know”)
Consciousness / alertness
Altered (drowsy or hyper-alert)
Clear until late
Clear
Memory pattern
Poor registration (inattention)
Recent memory loss predominates
Inconsistent; effort-dependent
Reversibility
Usually YES — find the cause
No (but risk is reducible)
Yes — treatable
First move
Screen (4AT/CAM) & hunt the cause
Support, structure, dignity
Screen, treat, follow up
Reversible causes — the PINCH·ME checklist. A bedside companion to the DELIRIUM mnemonic (§03), it captures the precipitants most often found and fixed without a sedative:
Letter
Reversible cause
What to check at the bedside
P
Pain
Unrelieved or unasked-about pain, especially in patients who cannot tell you
I
Infection
UTI, chest, skin, line; new confusion may be the only sign — fever often absent
Acute change in attention or awareness from baseline — treat as delirium until proven otherwise
Hypoactive picture (quiet, drowsy, withdrawn) — the most missed and the most lethal; screen, do not relax
New fever, dysuria, hypoxia, or hypoglycaemia — suspect a reversible precipitant now
A new or increased sedative, opioid, or anticholinergic on the list — review the whole list
Any safety threat (pulling lines, falls risk, distress) — escalate to the prescriber; sedation is the last rung, not the first
Clinical Reality
The trap is the chart that already says “dementia.” Once that word is on the page, every new confusion gets attributed to it — and an acute, reversible delirium goes unrecognized. The label becomes the patient. Observe the human first: what was their baseline yesterday, last week, before this admission?
The Decisive Question
Dementia and depression evolve over weeks to years. Delirium arrives over hours to days and fluctuates. So the bedside question is simple and powerful: “Is this an acute change from the patient’s usual self?” If yes — especially with impaired attention — treat it as delirium and start hunting for the cause.
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