Chris Miller

Consultant Geriatrician with speciality interests in Community and Interface Geriatrics. All views are mine

[Alasdair MacLullich @A_MacLullich]

❗️NHS ENGLAND POLICY

↳ "Patients aged over 65 presenting to hospital as an emergency

should be assessed by a competent clinical decision-maker within 30 minutes of arrival

using the Clinical Frailty Scale (CFS) & the 4AT tool for delirium."

#delirium #MedTwitter #frailty

[Alasdair MacLullich @A_MacLullich]

This 2005 study by Andrew, Freter & Rockwood was one of the first to show that when doctors didn't recognise delirium, outcomes were significantly worse.

68% of patients had poor outcomes at 6 months. But the most striking finding: poor recognition by the treating team was associated with 18x higher odds of death or functional decline.

Twenty years on, under-recognition remains the single most fixable problem in delirium care.

Are we any better at it now?

#delirium #geriatrics

[Chris Miller @confuseddoc]

@geriatricgiant 💯 agree. But the aim here isn't discharge (flow & system benefit). Instead enabling person centred care, listening to preferences of where they want to be & enabling those preferences to be delivered (patient benefit) whilst recognising/being open & honest about risks

[Tom Hutchinson @geriatricgiant]

Frailty musing: (unfortunately) in present systems, once you realise that your frail patient has a 50:50 chance of improving vs worsening in acute care - you can start discharging many more patients

[Alasdair MacLullich @A_MacLullich]

When screening rates hit 91% completion across an entire country's hip fracture population & people still try to tell you delirium screening can't be done at scale.

18,040 patients 🙌

The evidence has entered the building.

[Alasdair MacLullich @A_MacLullich]

⭐ New delirium resource: 50 free clinical cases to practice 4AT #delirium scoring

12 healthcare settings. 3 difficulty levels. Read the case, note your score, then click 'Show Worked Solution'.

No login. No ads. Just learning.

Please RT & share with colleagues!

Link 👇

[Alasdair MacLullich @A_MacLullich]

"You can't properly assess for delirium when someone already has dementia."

Wrong.

New meta-analysis (Keane et al. 2026): 4AT shows 88% sensitivity, 79% specificity in dementia populations.

5 studies. 1,304 patients. International data.

#delirium #dementia

[Alasdair MacLullich @A_MacLullich]

Have you ever wondered about the components of the 4AT delirium assessment tool?

This video of <3 mins walks through each element of the 4AT.

Also available on YouTube - link below.

--> If useful, please share with colleagues who screen for delirium.

#delirium

[JAGS @AGSJournal]

When Delirium Unmasks a Silent Myocardial Infarction. #geriatrics https://t.co/YAwPDKjWfE

[Alasdair MacLullich @A_MacLullich]

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.

[Alasdair MacLullich @A_MacLullich]

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.

[Alasdair MacLullich @A_MacLullich]

Older person confused. Urine dipped. 'Positive'. Antibiotics. Feeling of "job done."

Except: delirium missed, true causes not found, patient discharged still confused. 🫥🫥🫥

➡️ New confusion = delirium.

Same attention needed as chest pain or acute kidney injury. 👍👍👍

[Alasdair MacLullich @A_MacLullich]

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.

[British Geriatrics Society @GeriSoc]

Our Integrated Systems resources are here to support you in creating frailty and age-attuned systems.
These include top tips, template job descriptions, video conversations, and blogs. So, steal with pride, and take advantage of what others have learned. https://t.co/uuctjjeKcm

[British Geriatrics Society @GeriSoc]

To support prescribing decisions for older people with moderate to severe frailty, we recently published our Pragmatic Prescribing guidance. Endorsed by the @rpharms, the @rcgp, @RCPEdin, and the @RCPhysicians, this document was an instant hit. https://t.co/XaIyzu5q1f

[British Geriatrics Society @GeriSoc]

Interface roles are becoming more common across the country, with more consultant geriatricians working across community and acute settings.
Our Integrated Systems resource has a top tips page for recruiting to Interface Consultant posts.
https://t.co/51g1QFFOND

[Alasdair MacLullich @A_MacLullich]

All these informal terms - avoiding saying "delirium" - makes care FAR less effective.

Use #DELIRIUM.

[British Geriatrics Society @GeriSoc]

In May, we celebrated our inaugural #ChooseGeriatrics week, during which we shared blogs and videos from people across the MDT celebrating their choice to work in older people’s healthcare. Read our blogs here: https://t.co/maQ0ItU9xd

[British Geriatrics Society @GeriSoc]

On the second day of BGS…
In August, we co-produced the report “Hospital at home for frailty” with @UKHaHSoc. Hospital at Home, also referred to as virtual wards, enables people to remain at home while receiving the diagnosis and treatment they need. https://t.co/CCvG4CGBVf

[British Geriatrics Society @GeriSoc]

Welcome to the 1st day of BGS! Over the next 12 days, we'll be celebrating our highlights of 2025.
July saw the launch of a brand new BGS resource hub on Comprehensive Geriatric Assessment. CGA is the cornerstone of good quality care for older people. https://t.co/9xOFb28IU4