Screening instruments for delirium in older people with an acute medical illness

thereby increasing the risk of cholangitis and thus the overall morbidity. Both cholangiocarcinoma and pancreatic cancers were found more commonly in the elderly group. Metal stenting is performed in cases where surgery is not an option and this is reflected in the higher number of these stents in the elderly population with malignant strictures. In contrast, plastic stenting provides temporary relief of obstructive symptoms prior to more definitive surgical intervention. This is reflected in more frequent insertion of these stents in the younger population. ERCP is being increasingly utilised in the elderly population at high risk undergoing invasive procedures. It remains a technically feasible and safe procedure with a low rate of complications in this population. r ERCP is being increasingly utilised in the elderly population. r ERCP in the elderly is a technically feasible procedure with a high success rate, comparable with a younger population. r ERCP in the elderly is a safe procedure with a low complication risk, comparable with a younger population. Supplementary data are available at Age and Ageing online. Assimakopoulos SF et al. Endo-scopic retrogade cholangiopancreatography is safe and effective method for diagnosis and treatment of biliary and pancre-atic disorders in octogenarians. A, Hubner D et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. SIR—As a medical professional we are not especially good at diagnosing delirium in older people, with up to two-thirds of cases being either misdiagnosed or undetected [1]. This is largely due to many of the older people having dementia, with the features of delirium often difficult to distinguish. Delirium is associated with significant morbidity and mortality in older people, and their protracted hospital stays [2] have implications for finances and bed availability within our healthcare service. Any steps taken to improve the diagnosis and management of this syndrome would be of great benefit to both patients and the NHS. The British Geriatrics Society (BGS) recently produced clinical guidelines to improve prevention, diagnosis and management of delirium in older people in hospital [3]. In these guidelines, diagnosis of delirium is aided by screening for cognitive impairment on admission using the Abbreviated Mental Test (AMT) or Mini-Mental State Examination (MMSE), followed by the CAM screening instrument to confirm delirium [4, 5].