Alasdair MacLullich
@amaclullich.bsky.social
Physician & Professor of Geriatric Medicine @EdinburghUni.
Chair, Scottish Hip Fracture Audit.
Delirium, hip fracture.
Free chapter of new book: https://www.the4at.com/family-delirium-guide
Chair, Scottish Hip Fracture Audit.
Delirium, hip fracture.
Free chapter of new book: https://www.the4at.com/family-delirium-guide
Pinned
There's a real gap in public information on #delirium & I'm aiming to help address this with this book.
Get a pdf of Chapter 1 via this link:
www.the4at.com/family-delir...
#familycaregiver
Get a pdf of Chapter 1 via this link:
www.the4at.com/family-delir...
#familycaregiver
February 2, 2026 at 5:03 PM
HYPOACTIVE DELIRIUM: The one we miss
Many people picture delirium as agitation and confusion.
But 75% of delirium is HYPOACTIVE:
- Quiet
- Withdrawn
- Easy to miss
It has WORSE outcomes than hyperactive delirium.
What's your experience with hypoactive delirium?
Many people picture delirium as agitation and confusion.
But 75% of delirium is HYPOACTIVE:
- Quiet
- Withdrawn
- Easy to miss
It has WORSE outcomes than hyperactive delirium.
What's your experience with hypoactive delirium?
February 2, 2026 at 7:58 AM
HYPOACTIVE DELIRIUM: The one we miss
Many people picture delirium as agitation and confusion.
But 75% of delirium is HYPOACTIVE:
- Quiet
- Withdrawn
- Easy to miss
It has WORSE outcomes than hyperactive delirium.
What's your experience with hypoactive delirium?
Many people picture delirium as agitation and confusion.
But 75% of delirium is HYPOACTIVE:
- Quiet
- Withdrawn
- Easy to miss
It has WORSE outcomes than hyperactive delirium.
What's your experience with hypoactive delirium?
"The nurse smiles as she brings your dinner. But you KNOW something's wrong with it. You can't explain why, but you're certain."
What does it feel like to believe the food on your hospital tray is poisoned?
#delirium
What does it feel like to believe the food on your hospital tray is poisoned?
#delirium
February 1, 2026 at 10:12 PM
"The nurse smiles as she brings your dinner. But you KNOW something's wrong with it. You can't explain why, but you're certain."
What does it feel like to believe the food on your hospital tray is poisoned?
#delirium
What does it feel like to believe the food on your hospital tray is poisoned?
#delirium
"Do not use antipsychotic drugs for the non-cognitive symptoms or behaviour that challenges in people with dementia unless the person is severely distressed or there is an immediate risk of harm to them or others."
— UK NICE Guideline on Dementia
— UK NICE Guideline on Dementia
January 31, 2026 at 9:17 PM
"Do not use antipsychotic drugs for the non-cognitive symptoms or behaviour that challenges in people with dementia unless the person is severely distressed or there is an immediate risk of harm to them or others."
— UK NICE Guideline on Dementia
— UK NICE Guideline on Dementia
"He saw visions of his ancestors, they were calling him, he could not understand."
Love in the Time of Cholera, Gabriel García Márquez
#delirium
Love in the Time of Cholera, Gabriel García Márquez
#delirium
January 31, 2026 at 12:04 PM
"He saw visions of his ancestors, they were calling him, he could not understand."
Love in the Time of Cholera, Gabriel García Márquez
#delirium
Love in the Time of Cholera, Gabriel García Márquez
#delirium
Let's look at delirium and dementia:
Episodes of delirium: more rapid progression of dementia.
Delirium survivors: x3-fold higher risk of future dementia.
➡️ We really need the support of dementia charities in helping improve delirium care.
#delirium #dementia #medtwitter
Episodes of delirium: more rapid progression of dementia.
Delirium survivors: x3-fold higher risk of future dementia.
➡️ We really need the support of dementia charities in helping improve delirium care.
#delirium #dementia #medtwitter
January 30, 2026 at 4:41 PM
Let's look at delirium and dementia:
Episodes of delirium: more rapid progression of dementia.
Delirium survivors: x3-fold higher risk of future dementia.
➡️ We really need the support of dementia charities in helping improve delirium care.
#delirium #dementia #medtwitter
Episodes of delirium: more rapid progression of dementia.
Delirium survivors: x3-fold higher risk of future dementia.
➡️ We really need the support of dementia charities in helping improve delirium care.
#delirium #dementia #medtwitter
January 30, 2026 at 7:53 AM
🧠 Delirium = the only dedicated delirium journals.
👍100% open access.
👍Ultra-low fees ($20 submission, $280 publication).
👍All study types welcome & rapid 4-week peer review.
#delirium #medtwitter
👍100% open access.
👍Ultra-low fees ($20 submission, $280 publication).
👍All study types welcome & rapid 4-week peer review.
#delirium #medtwitter
January 29, 2026 at 4:45 PM
🧠 Delirium = the only dedicated delirium journals.
👍100% open access.
👍Ultra-low fees ($20 submission, $280 publication).
👍All study types welcome & rapid 4-week peer review.
#delirium #medtwitter
👍100% open access.
👍Ultra-low fees ($20 submission, $280 publication).
👍All study types welcome & rapid 4-week peer review.
#delirium #medtwitter
Emergency Department (ED) staff: screen ALL patients over 65 for delirium.
Emergency departments are where it's most missed and most dangerous.
Make it as routine as checking blood pressure.
Emergency departments are where it's most missed and most dangerous.
Make it as routine as checking blood pressure.
January 29, 2026 at 7:49 AM
Emergency Department (ED) staff: screen ALL patients over 65 for delirium.
Emergency departments are where it's most missed and most dangerous.
Make it as routine as checking blood pressure.
Emergency departments are where it's most missed and most dangerous.
Make it as routine as checking blood pressure.
January 28, 2026 at 8:06 AM
⭐ META-ANALYSIS: Hospital delirium --> devastating long-term outcomes
253 studies, 137,000+ pts:
• 5.4x dementia risk
• 2.8x institutionalisation
• 2.5x mortality
• 1.7x readmission
⚠️ Delirium = a serious acute problem AND a risk warning.
➡️ All pts deserve robust delirium assessment
253 studies, 137,000+ pts:
• 5.4x dementia risk
• 2.8x institutionalisation
• 2.5x mortality
• 1.7x readmission
⚠️ Delirium = a serious acute problem AND a risk warning.
➡️ All pts deserve robust delirium assessment
January 27, 2026 at 7:58 AM
⭐ META-ANALYSIS: Hospital delirium --> devastating long-term outcomes
253 studies, 137,000+ pts:
• 5.4x dementia risk
• 2.8x institutionalisation
• 2.5x mortality
• 1.7x readmission
⚠️ Delirium = a serious acute problem AND a risk warning.
➡️ All pts deserve robust delirium assessment
253 studies, 137,000+ pts:
• 5.4x dementia risk
• 2.8x institutionalisation
• 2.5x mortality
• 1.7x readmission
⚠️ Delirium = a serious acute problem AND a risk warning.
➡️ All pts deserve robust delirium assessment
Noting that a patient is "confused" just isn't enough.
Don't assume any cognitive impairment is dementia - it may be delirium.
A brief conversation with the family can provide critical information.
#Delirium
Don't assume any cognitive impairment is dementia - it may be delirium.
A brief conversation with the family can provide critical information.
#Delirium
January 26, 2026 at 5:03 PM
Noting that a patient is "confused" just isn't enough.
Don't assume any cognitive impairment is dementia - it may be delirium.
A brief conversation with the family can provide critical information.
#Delirium
Don't assume any cognitive impairment is dementia - it may be delirium.
A brief conversation with the family can provide critical information.
#Delirium
Day team handover: "Bed 4 is a bit muddled."
Night team discovery: patient trying to leave via the window, convinced staff are poisoning them, BP 88/57, sats 91%, obv pneumonia.
"Muddled" doing a lot of heavy lifting there.
#delirium
Night team discovery: patient trying to leave via the window, convinced staff are poisoning them, BP 88/57, sats 91%, obv pneumonia.
"Muddled" doing a lot of heavy lifting there.
#delirium
January 26, 2026 at 7:58 AM
Day team handover: "Bed 4 is a bit muddled."
Night team discovery: patient trying to leave via the window, convinced staff are poisoning them, BP 88/57, sats 91%, obv pneumonia.
"Muddled" doing a lot of heavy lifting there.
#delirium
Night team discovery: patient trying to leave via the window, convinced staff are poisoning them, BP 88/57, sats 91%, obv pneumonia.
"Muddled" doing a lot of heavy lifting there.
#delirium
Mesopotamian Diagnostic Handbook (Sakikkû) ~1050 BC:
"If a stroke has struck him & his forehead seizes him all the time, he sees his providing spirit; variant: he sees the Provider-of-Evil; he will die."
One of the earliest known descriptions of #delirium
"If a stroke has struck him & his forehead seizes him all the time, he sees his providing spirit; variant: he sees the Provider-of-Evil; he will die."
One of the earliest known descriptions of #delirium
January 25, 2026 at 2:01 PM
Mesopotamian Diagnostic Handbook (Sakikkû) ~1050 BC:
"If a stroke has struck him & his forehead seizes him all the time, he sees his providing spirit; variant: he sees the Provider-of-Evil; he will die."
One of the earliest known descriptions of #delirium
"If a stroke has struck him & his forehead seizes him all the time, he sees his providing spirit; variant: he sees the Provider-of-Evil; he will die."
One of the earliest known descriptions of #delirium
"People with dementia can become frightened and anxious in hospital. They may not understand where they are or why they are there. They may have difficulties with communication and in making their needs known."
— Social Care Institute for Excellence (SCIE)
— Social Care Institute for Excellence (SCIE)
January 24, 2026 at 9:17 PM
"People with dementia can become frightened and anxious in hospital. They may not understand where they are or why they are there. They may have difficulties with communication and in making their needs known."
— Social Care Institute for Excellence (SCIE)
— Social Care Institute for Excellence (SCIE)
A casual record of 'new confusion' or worse, just 'confusion', is imprecise & prevents clear treatment & communication.
It's lazy, imprecise & harmful.
Be professional.
Upgrade.
Use the right technical term: 𝐝𝐞𝐥𝐢𝐫𝐢𝐮𝐦.
#delirium #encephalopathy
It's lazy, imprecise & harmful.
Be professional.
Upgrade.
Use the right technical term: 𝐝𝐞𝐥𝐢𝐫𝐢𝐮𝐦.
#delirium #encephalopathy
January 24, 2026 at 1:31 PM
A casual record of 'new confusion' or worse, just 'confusion', is imprecise & prevents clear treatment & communication.
It's lazy, imprecise & harmful.
Be professional.
Upgrade.
Use the right technical term: 𝐝𝐞𝐥𝐢𝐫𝐢𝐮𝐦.
#delirium #encephalopathy
It's lazy, imprecise & harmful.
Be professional.
Upgrade.
Use the right technical term: 𝐝𝐞𝐥𝐢𝐫𝐢𝐮𝐦.
#delirium #encephalopathy
"In the deepest slumber—no! In #delirium—no! In a swoon—no! In death—no! even in the grave all is not lost. Else there is no immortality for man."
The Pit and the Pendulum by Edgar Allan Poe
January 24, 2026 at 12:04 PM
"In the deepest slumber—no! In #delirium—no! In a swoon—no! In death—no! even in the grave all is not lost. Else there is no immortality for man."
The Pit and the Pendulum by Edgar Allan Poe
Brief video walkthrough of the 4AT delirium assessment tool. It's easy!
Also on youtube: youtu.be/ncbgH_Pnkqk?...
Please repost / share.
#delirium #4AT
Also on youtube: youtu.be/ncbgH_Pnkqk?...
Please repost / share.
#delirium #4AT
January 23, 2026 at 10:14 PM
Brief video walkthrough of the 4AT delirium assessment tool. It's easy!
Also on youtube: youtu.be/ncbgH_Pnkqk?...
Please repost / share.
#delirium #4AT
Also on youtube: youtu.be/ncbgH_Pnkqk?...
Please repost / share.
#delirium #4AT
Let's look at delirium and dementia:
Episodes of delirium: more rapid progression of dementia.
Delirium survivors: x3-fold higher risk of future dementia.
➡️ We really need the support of dementia charities in helping improve delirium care.
#delirium #dementia #medtwitter
Episodes of delirium: more rapid progression of dementia.
Delirium survivors: x3-fold higher risk of future dementia.
➡️ We really need the support of dementia charities in helping improve delirium care.
#delirium #dementia #medtwitter
January 23, 2026 at 4:41 PM
Let's look at delirium and dementia:
Episodes of delirium: more rapid progression of dementia.
Delirium survivors: x3-fold higher risk of future dementia.
➡️ We really need the support of dementia charities in helping improve delirium care.
#delirium #dementia #medtwitter
Episodes of delirium: more rapid progression of dementia.
Delirium survivors: x3-fold higher risk of future dementia.
➡️ We really need the support of dementia charities in helping improve delirium care.
#delirium #dementia #medtwitter
The math isn't mathing. 🧠
Delirium screening: 2 minutes with the 4AT.
Consequences of missed delirium: patient & carer suffering, increased length of stay, & potentially higher risks of future cognitive decline & new need for a care home.
Yet some still say that we are "too busy" to screen.
Delirium screening: 2 minutes with the 4AT.
Consequences of missed delirium: patient & carer suffering, increased length of stay, & potentially higher risks of future cognitive decline & new need for a care home.
Yet some still say that we are "too busy" to screen.
January 23, 2026 at 2:13 PM
The math isn't mathing. 🧠
Delirium screening: 2 minutes with the 4AT.
Consequences of missed delirium: patient & carer suffering, increased length of stay, & potentially higher risks of future cognitive decline & new need for a care home.
Yet some still say that we are "too busy" to screen.
Delirium screening: 2 minutes with the 4AT.
Consequences of missed delirium: patient & carer suffering, increased length of stay, & potentially higher risks of future cognitive decline & new need for a care home.
Yet some still say that we are "too busy" to screen.