From Acute Confusion to Chronic Decline: The Cognitive Impact of Delirium in Older Adults.

Delirium is prevalent in healthcare settings, leaving susceptible older adults at risk for persistent cognitive impairment, prolonged care needs, morbidity, and mortality. In older adult patients, delirium often arises from acute medical illnesses, infections, medications, and comorbidities, with age and underlying dementia increasing susceptibility. Its complex pathophysiology involves systemic inflammation, neurotransmitter dysregulation, disrupted brain metabolism, and physiological cycle disturbances. While delirium causes acute cognitive impairments, patients are often left with persistent dysfunction. Moreover, patients with pre-existing cognitive impairment are at higher risk for developing dementia or accelerated cognitive decline in the wake of a delirium episode. Delirium also worsens long-term quality of life, increasing risk for functional disability and need for institutional care. Prevention and management strategies focus on prophylaxis, early intervention, multicomponent programs, and pharmacological interventions, while ongoing research seeks to identify biomarkers and improve delirium detection and long-term management.