Almost every nurse at one time or another has dealt with a patient who was confused, combative or agitated. Many nurses assume the elderly person has dementia. However, the vast majority of them are actually suffering from a serious emergency known as delirium. Delirium is four times more common in older people than in younger people. Nurses need to be more diligent in the identification and treatment of this potentially fatal condition.

Dementia is a clinical syndrome caused by a wide range of diseases that affect the brain. Its core feature is a decline in cognition. The word dementia derives from the Latin de mens and means �from the mind�. Its mention in the Bible and in early Egyptian, Greek, and Roman writings suggests that it has affected humankind since the dawn of time (Rabins et el, 1999). The three key characteristics of this condition are; a decline in cognitive capacity (memory, language, judgment, etc.), multiple areas of cognition impaired, and a normal level of consciousness. According to the Alzheimer's Society , approximately 364,000 Canadians over the age of 65 have some form of dementia (2002).

The hallmark of delirium is impairment in level of consciousness or sensorium. Delirium is usually accompanied by a range of mental symptoms such as irritability, visual or auditory hallucinations, delusions, depression, euphoria and social withdrawal. It is a condition in which the patient is drowsy, inattentive, or unable to sustain concentration, and in which multiple impairments in thinking are present. Most cases of delirium begin suddenly and the symptoms usually resolve with treatment of the underlying cause.