Facilitation of Health Plan-Clinic Partnerships to Improve Colorectal Cancer Screening for Rural Medicaid Enrollees: A Qualitative Study.

Delirium is a severe and acute neuropsychiatric syndrome characterized by disturbances in attention, awareness, and cognition, with symptoms that fluctuate over time. It is highly prevalent among older adults and is associated with adverse clinical outcomes, including prolonged hospitalization, increased healthcare costs, functional decline, institutionalization, and mortality. Older adults frequently present to the emergency department (ED) with confusion, agitation, or behavioral changes, and these symptoms are more often due to underlying medical conditions than to primary psychiatric disorders. As the global population ages, the number of elderly patients presenting to the ED is expected to increase substantially. Delirium is particularly underrecognized in the ED setting, despite reported prevalence rates ranging from 7 to 20%. Studies have shown that delirium is an independent predictor of mortality and long-term cognitive decline. The ED environment itself (including sensory overload, sleep disruption, time pressure, and frequent patient transfers) may further predispose older adults to delirium. Moreover, older patients often have multiple comorbidities, polypharmacy, and atypical clinical presentations, which complicate early detection and management. Early recognition of delirium is essential because it is often reversible when underlying causes are promptly identified and treated. Screening tools such as the confusion assessment method (CAM) for the intensive care unit (ICU) (CAM-ICU) have demonstrated high sensitivity and specificity in the ED setting and significantly increase diagnostic rates compared with routine clinical assessment. However, standardized screening remains under-implemented in routine emergency practice.