CASES OF NOTEAssessment and Management of Delirium in Older Adults in the Emergency Department Literature Review to Inform Development of a Novel Clinical ProtocolRosen, Tony MD, MPH; Connors, Scott BS; Clark, Sunday MPH, ScD; Halpern, Alexis MD; Stern, Michael E. MD; DeWald, Jennifer RN; Lachs, Mark S. MD, MPH; Flomenbaum, Neal MDAuthor Information Division of Emergency Medicine (Drs Rosen, Clark, Halpern, Stern, and Flomenbaum, Mr Connors, and Ms DeWald) and Division of Geriatrics and Palliative Medicine (Mr Connors and Dr Lachs), Weill Cornell Medical College, New York. Corresponding Author: Tony Rosen, MD, MPH, Division of Emergency Medicine, Box 179, Weill Cornell Medical College, 525 East 68th St, New York, NY 10065 (firstname.lastname@example.org). The authors are grateful to the American Federation of Aging Research, which provided the funding for Scott Connors' participation through its Medical Student Training in Aging Research fellowship program. Dr Mark Lachs is the recipient of a mentoring award in patient-oriented research from the National Institute on Aging (K24 AG022399). Disclosure: The authors report no conflicts of interest. Advanced Emergency Nursing Journal: July/September 2015 - Volume 37 - Issue 3 - p 183-196 doi: 10.1097/TME.0000000000000066 Buy Take the CE Test Metrics Abstract Delirium occurs frequently in older patients in the emergency department (ED), is underrecognized, and has potentially serious consequences. Despite its seriousness, delirium is frequently missed by emergency providers, and patients with unrecognized delirium are often discharged from the ED. Even when it is appropriately recognized, managing delirium in older adults poses a significant challenge for ED providers. Geriatric delirium is typically caused by the interaction of multiple factors, including several that are commonly missed: pain, urinary retention, constipation, dehydration, and polypharmacy. Appropriate management includes nonpharmacological management with medication intervention reserved for emergencies. We have developed a new, comprehensive, evidence-based protocol for diagnosis/recognition, management, and disposition of geriatric delirium patients in the ED with a focus on identifying and treating commonly missed contributing causes. Copyright © Wolters Kluwer Health, Inc. All rights reserved.