Delirium in Hospitalized Older Adults: A Narrative Review

Delirium is a common and serious neuropsychiatric syndrome in hospitalized elderly patients, characterized by acute disturbances in attention, awareness, and cognition. It affects a significant proportion of older adults admitted for acute medical illness and an even greater proportion of those undergoing major surgical procedures, such as hip fracture repair or cardiac surgery. Delirium is independently associated with prolonged hospitalization, institutionalization, functional decline, long-term cognitive impairment, and increased mortality. Despite its prevalence and clinical impact, delirium remains frequently underrecognized, particularly in its hypoactive form, which often presents with subtle symptoms such as lethargy, withdrawal, and reduced responsiveness. Delayed recognition can contribute to preventable complications and poorer outcomes in vulnerable elderly patients. This narrative review examines literature published between 2005 and 2026 on delirium in hospitalized older adults. It explores the pathophysiology, risk factors, clinical presentation, and diagnostic frameworks used to identify delirium. It also summarizes current guideline-based strategies for the prevention and management of delirium, including both pharmacologic and non-pharmacologic approaches. Improving recognition and management of delirium in hospitalized elderly patients remains an important clinical priority. Greater integration of guideline-based screening and prevention strategies into routine hospital practice may help reduce the incidence of delirium and mitigate its long-term consequences.