Managing delirium: moving beyond a single cause mindset

Stokel-Walker correctly highlights that, despite its prevalence and serious consequences, delirium remains under-recognised and poorly managed.1 One reason we continue to “do little” is our persistent diagnostic tunnel vision—particularly the tendency to treat delirium as solely secondary to infection.As a foundation year 2 doctor, I frequently encounter acutely confused patients on night shifts. The default assumption is infection, prompting comprehensive septic screens. But sometimes infection is not present, and other factors emerge, such as recent medication changes, environmental disruption, sleep deprivation, or inadequately managed pain—showing the multifactorial nature of delirium.These contributors are well supported in the literature. Polypharmacy and psychoactive drug use are major contributors, as are environmental factors such as sensory deprivation, noise, and ward transfers.2 When the medication is stopped and routine stabilised, cognition can improve within days—without antibiotics. Another major problem is sleep disturbance, which is associated with an increased risk of delirium.3 Pain is also independently…