Delirium in older adults in the emergency department: a scoping review of current research and identified knowledge gaps.

BACKGROUND

Delirium is a common neurocognitive syndrome among older adults, associated with increased morbidity, mortality, and healthcare costs. Emergency departments (EDs) represent a critical point for early detection and prevention, yet delirium often remains under-recognized in this setting. Contributing factors include overcrowding, sensory overload, and lack of orientation aids, combined with demographic shifts leading to more acutely admitted older adults with complex needs. This scoping review aimed to map existing research on delirium in elderly patients in EDs and identify knowledge gaps.

METHODS

The review followed Joanna Briggs Institute methodology and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Structured searches were conducted in EMBASE, MEDLINE, CINAHL, Web of Science, Cochrane, and PsycINFO for studies published between 2015 and July 2024, updated in September 2025. After duplicate removal, two reviewers independently screened 1,455 titles and abstracts, applying refined inclusion and exclusion criteria. 178 publications were reviewed in the research group. A total of 114 publications were included for full-text analysis.

RESULTS

Publications represented all continents, except for Africa, and most originated from North America (n = 54) and Europe (n = 35). Through content analysis, studies were categorized into six themes: Prevention, Occurrence, Risk factors, Detection, Management, and Consequences. Occurrence (n = 55) and Detection (n = 47) were the largest categories, while Prevention was least represented (n = 10). Evidence indicates wide variability in reported prevalence, inconsistent screening practices, and limited intervention research. Key gaps include standardized screening protocols, staff training, and effective prevention and management strategies tailored to ED environments.

CONCLUSIONS

Delirium in older adults remains a significant challenge in EDs worldwide. This review synthesises current research on occurrence, risk factors, detection, and clinical outcomes, while highlighting critical gaps in strategies for prevention and management to secure optimal care. Despite valuable insights, evidence on effective prevention and the use of described toolkits in practice is limited. These gaps underscore the urgent need for targeted interventions and robust implementation research to improve recognition and care for this vulnerable patient population.