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If this was absent, premorbid cognition was determined by telephone interview using the Informant Questionnaire on Cognitive Decline in the Elderly-Short Form (IQCODE-SF), a validated screening tool for detecting cognitive impairment.21 22 In patients without delirium less than 65 years of age, if there was no dementia documentation in the case notes, the patient was presumed not to have the condition.As dementia is more common and is known to be under-diagnosed in older people, potentially dementia diagnosis may have been under-reported in the charts.All included patients were screened for delirium within a 6 h period in three phases of assessment, as follows.Junior staff questioned the patient as to whether they felt currently or recently confused (‘have you felt muddled in your thinking, or confused, since you came into hospital? Nursing staff were interviewed using standardised questions (see box 1).Thus, it seemed feasible to recruit sufficient patients to perform this study.On the day of the study, patients were excluded if they were severely aphasic, comatose, dying or deemed too unwell for interview by nursing staff; or refused to participate.The study objectives and procedures were explained to all patients and those who declined to participate were excluded.In all patients with delirium, the medical case notes were reviewed for a diagnosis of preceding cognitive impairment or dementia made by a suitably trained physician.

It has high inter-rater reliability, validity, sensitivity and specificity for distinguishing delirium from mixed neuropsychiatric conditions including dementia and depression.18–20 It is a 16-item scale with 13 severity items (rated 0–3) and three diagnostic items (rated 0–2 or 0–3); total score possible is 0–46.A meta-analysis of 42 studies reported delirium to be prevalent on admission in 10–31% of medical inpatients, and to occur in the hospital in 3–29%.6 However, these estimates are based on pooled findings from multiple studies within individual services or units, rather than a more complete study of a single hospital, and are limited by terminology differences and diagnostic tool heterogeneity.Thus, a definitive and accurate determination of inhospital delirium prevalence, using standardised delirium instruments, is needed.Results Using DSM-IV criteria, 55 of 280 patients (19.6%) had delirium versus 17.6% using the CAM.Using the DRS-R98 total score for independent diagnosis, 20.7% had full delirium, and 8.6% had subsyndromal delirium.

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Prevalence was higher in older patients (4.7% if Conclusions Our point prevalence study confirms that delirium occurs in about 1/5 of general hospital inpatients and particularly in those with prior cognitive impairment.