Mistaken delirium diagnosis in a Cantonese-speaking patient: impact of language barriers on clinical assessment of mental status

Delirium is a common but frequently misdiagnosed condition, particularly in patients with limited English proficiency. Language and other communication barriers can significantly affect assessments of mental status, leading to errors in diagnosis and management. A 94-year-old Cantonese-speaking male was hospitalized with a subdural hematoma after an unwitnessed fall. During his hospitalization, staff observed apparent altered mental status, poor attention, disorganized responses, and agitation. Given these findings, interventions such as restraints and antipsychotics were considered. However, the patient's language barrier had not been fully accounted for. Further evaluation using a professional Cantonese interpreter and a formal Confusion Assessment Method (CAM) instrument revealed that the patient was cognitively intact. His apparent inattention and disorganized thinking resulted from communication difficulties rather than delirium. Once appropriate language support was provided, his mental status was re-assessed and delirium was ruled out, and the planned interventions were held, preventing iatrogenic harm. Language barriers can significantly impact delirium assessments, leading to misdiagnosis and improper management. Using interpreter services combined with standardized delirium screening instruments is crucial in improving diagnostic accuracy of mental status assessment in non-English-speaking patients. As the aging population becomes more diverse, language-concordant care must be prioritized to ensure patient-centered care.