Delirium in Older People Across Care Settings in Viet Nam: Why Prevention, Early Recognition and Safe Management Matter for Quality and Safety

Delirium in Older People Across Care Settings in Viet Nam: Why Prevention, Early Recognition and Safe Management Matter for Quality and Safety

AGE-FRIENDLY CARE QUALITY, INTEGRATED CARE & CARE TRANSITIONS

Last reviewed: October 2026

An older person is admitted to hospital with pneumonia. The next morning, they seem unusually sleepy, answer questions slowly and barely touch breakfast. By evening, they are restless and repeatedly trying to get out of bed. Their family says, “This is not how they normally are.”

It can be tempting to attribute the change to age, dementia, poor sleep or simply being in hospital. But a sudden change in attention, awareness, thinking or behavior in an older person may be delirium, a common and serious clinical condition that can signal acute illness, medication-related harm or another underlying problem.

For healthcare organizations, the quality issue is not only whether delirium is eventually diagnosed. It is whether preventable risks are reduced, acute change is recognized early, possible causes are investigated promptly, management avoids adding further harm, and relevant information follows the person when care moves between hospital, rehabilitation, home, community services and long-term care.

The issue is particularly timely in 2026. WHO is developing its first global guideline on the prevention, diagnosis and management of delirium in older adults, explicitly including medication safety and deprescribing. As of September 2026, WHO was still establishing the evidence-review process and methodological requirements, with further methodological work expected in 2027. The forthcoming guideline should therefore not yet be presented as a completed WHO recommendation.

Delirium is an acute change, not another name for dementia

Delirium and dementia can both affect memory, orientation, attention and behavior, but they are not the same condition. Delirium typically develops over hours or days and may fluctuate substantially during the day. A person may be restless and alert at one point, then quiet, sleepy and difficult to engage several hours later. Dementia usually develops more gradually, although people living with dementia can also develop delirium.

This distinction matters because a sudden change should not be dismissed simply because the person already has cognitive impairment. Current NICE guidance recommends looking for recent or fluctuating changes in cognition, perception, physical function or social behavior and specifically warns clinicians to be alert to hypoactive delirium, where the person may become withdrawn, slow to respond, less mobile or less interested in eating rather than obviously agitated. These quieter presentations can be particularly easy to miss.

A person with dementia who suddenly becomes much more confused may therefore have delirium superimposed on dementia, rather than simple progression of the underlying condition. When it is difficult to distinguish between delirium, dementia and delirium superimposed on dementia, NICE advises managing the possible delirium first.

For families and regular caregivers, one of the most useful questions can be simple:

“Is this different from how the person normally thinks, communicates or behaves?”

Knowing the person’s baseline is often critical.

Delirium is common, but the numbers vary greatly by setting

WHO describes delirium as common, serious and often preventable in older adults, while noting that it remains under-recognized, underdiagnosed and suboptimally managed across acute care, intensive care, long-term care and community settings. It is associated with increased morbidity, mortality, functional decline and healthcare costs.

A 2025 systematic review and meta-analysis of 35 studies involving 12,097 medically hospitalized older people estimated pooled delirium prevalence at 23.6% and pooled incidence during hospitalization at 13.5%. Findings varied substantially between studies and countries. Frailty, cognitive impairment, severe illness, previous falls and physical restraints were among factors associated with greater delirium risk.

Viet Nam also has relevant local evidence, although it needs careful interpretation. A 2021 cross-sectional study at the National Geriatric Hospital in Ha Noi included 163 non-surgical patients admitted to emergency and intensive-care settings and reported delirium in 63.1% of the sample. Because this was a convenience sample of acutely ill patients in particularly high-risk settings, that figure should not be interpreted as the prevalence of delirium among older people in Vietnamese hospitals generally. It nevertheless shows that delirium is highly relevant in Vietnamese geriatric acute care.

The practical message is not that every organization needs to adopt one prevalence figure. It is that delirium is common and consequential enough for older-person services to need a reliable way to prevent, recognize and respond to it.

Prevention requires multicomponent care

Delirium rarely has one simple cause, so prevention rarely depends on one intervention. WHO’s current guideline-development materials identify medication-related factors such as polypharmacy and inappropriate prescribing as important contributors, while also noting infections, dehydration, environmental stressors and other acute physiological disturbances as potential precipitants.

Current evidence supports multicomponent non-pharmacological prevention, although certainty and study designs vary across reviews. A 2026 systematic review and meta-analysis of 87 randomized trials involving 19,289 older adults found that multicomponent non-pharmacological interventions reduced delirium occurrence compared with usual care. The pooled effect was favorable, but certainty for that result was rated very low because of methodological limitations and heterogeneity.

A separate 2026 systematic review and meta-analysis of 21 studies involving 6,354 hospitalized older adults examined nurse-led or nurse-coordinated multicomponent interventions. It found a lower incidence of delirium and reported moderate-certainty evidence overall, highlighting the central role nursing can play in making prevention happen reliably at the bedside.

The precise combination of interventions differs among programs, but the underlying principle is consistent: address multiple modifiable risks together. Depending on the person and setting, this may include supporting orientation, hydration and nutrition; promoting sleep; managing pain; enabling clinically appropriate mobility; ensuring glasses and hearing aids are available; reviewing medications; reducing unnecessary disruption; and involving familiar family members or caregivers where helpful. NICE similarly recommends a tailored multicomponent intervention package for people at risk.

Many of these components are not “special delirium treatments.” They are simply good age-friendly care delivered consistently.

Early recognition starts with knowing the person’s baseline

One reason delirium is missed is that healthcare staff may meet an older person only after the acute illness has already changed them. A clinician sees an 82-year-old who is confused and assumes this is their usual cognition. A quiet patient who sleeps much of the day may be considered easy to care for rather than acutely unwell. A long-term-care resident returning from hospital may remain confused, but the receiving team may not know whether that confusion began before, during or after the admission.

Families and regular caregivers can provide information that a test cannot: what is normal for this person?

Structured assessment can then support recognition. NICE currently recommends the 4AT when indicators of delirium are identified outside critical care, and the CAM-ICU or Intensive Care Delirium Screening Checklist (ICDSC) in critical care or postoperative recovery settings. If the assessment indicates delirium, final diagnosis should be made by a healthcare professional with the relevant expertise. These are international recommendations, not current national requirements in Viet Nam.

The more important implementation principle is that organizations need an agreed process:

notice acute change → assess promptly → document it → investigate possible causes → act.

A cognitive-screening score by itself is not a delirium pathway.

Treat the causes and manage the person safely

Delirium should be treated as a clinical signal, not simply as difficult behavior. A person who becomes agitated may be in pain, hypoxic, infected, dehydrated or experiencing medication-related harm. A person who becomes unusually quiet may have the same kinds of underlying problems.

WHO’s decision to include medication safety and deprescribing in its forthcoming guideline is important in this context. Older people commonly receive multiple medications, and medication-related risk may involve new medicines, dose changes, interactions, accumulation during organ dysfunction or combined sedating effects.

NICE places identification and management of the underlying cause, or combination of causes, at the beginning of delirium treatment. It also recommends effective communication, reorientation, reassurance and an appropriate care environment, with involvement of family, friends and caregivers where helpful.

This matters because the visible behavior can easily become the focus. Someone may pull at lines, attempt to leave, hallucinate, shout or repeatedly try to stand despite being unsteady. Another person may be quiet but frightened and disoriented. Pain, thirst, hunger, toileting needs, sensory impairment, sleep disturbance and environmental confusion all need attention rather than assuming agitation is purely psychiatric.

When severe distress or immediate risk persists despite non-pharmacological approaches, short-term pharmacological treatment may sometimes be considered by an appropriately qualified clinician. Such decisions require careful attention to indication, dose, duration, contraindications and individual risk, and specific medication choices should follow applicable clinical guidance. The WHO guideline now under development may eventually provide updated global recommendations, but no new WHO drug recommendation should be inferred before that process is complete.

The broader principle is more durable:

manage the person and the causes of delirium, not just the visible behavior.

Delirium care and information need to continue across transitions

Delirium does not always resolve on the day a person leaves hospital. An updated systematic review and meta-analysis of 23 studies involving 3,186 hospitalized older people estimated persistent delirium at discharge at 36%, with substantial variation between studies and persistence still documented at later follow-up.

This makes delirium a care-transition issue. An older person may leave acute care still needing reorientation, supervision, medication review, mobility support or follow-up. If discharge information does not clearly record that delirium occurred, the rehabilitation team, primary-care clinician, family or long-term-care service may interpret ongoing cognitive change as dementia or as the person’s new baseline.

Good transition information should therefore make clear that delirium occurred, what factors may have contributed, what has been treated or corrected, what remains uncertain, which relevant medication changes were made, what the person’s usual cognition was before the episode and what changes should trigger reassessment. NICE specifically recommends documenting delirium in the person’s records, including the primary-care record.

Family members can be particularly valuable here because they often know the baseline better than any single clinical team. They may be the first to notice that a person who was normally talkative has become unusually quiet, or that someone who always recognized family is suddenly uncertain. Their role is not to diagnose delirium but to communicate baseline and change: what was normal, when the change began, whether it fluctuates, what medicines were being used and whether a similar episode has happened before.

The wider quality lesson is straightforward: delirium may begin in one setting, but its effects and the information needed to manage them can travel with the person into the next.

Viet Nam has useful building blocks, but not a dedicated delirium pathway

Viet Nam’s 2026 guidance for home- and community-based older-person care contains several elements that are directly relevant to acute cognitive change. Ministry of Health Decision No. 1976/QĐ-BYT of 1 July 2026 includes ICOPE-based screening of intrinsic capacity and asks whether an older person has problems with memory or orientation, such as not knowing where they are or what day it is. When concerns are identified, the application proceeds to additional cognitive-screening questions.

Importantly, the guidance also recognizes “lú lẫn thoáng qua”, or transient confusion. It describes sudden loss of attention and orientation that occurs over a short period and may fluctuate during the day, and identifies acute causes such as infection, medications, metabolic disturbance and alcohol-related problems. It also notes that interactions between multiple medicines can cause adverse effects and identifies sedatives and sleeping medicines among drugs commonly associated with cognitive disturbance in older people.

These are highly relevant building blocks. They should not, however, be interpreted as a complete national delirium pathway. Decision 1976 does not establish a dedicated delirium assessment and management pathway comparable to a clinical delirium guideline, nor does its ICOPE component provide a validated delirium-specific assessment tool.

WHO’s ICOPE second edition has the same broader purpose. It supports primary and community care to detect losses in intrinsic capacity—including cognition, mobility, vitality, vision, hearing and psychological capacity—identify health and social-support needs, develop a personalized care plan and monitor implementation. It is not a delirium guideline.

This distinction matters. ICOPE cognitive screening is not the same as delirium assessment. A tool intended to identify loss of intrinsic cognitive capacity should not be assumed to distinguish dementia, mild cognitive impairment and an acute fluctuating delirium episode.

For Viet Nam, the implementation opportunity is to connect existing older-person assessment, medication-safety and community-care infrastructure with a clearer process for recognizing acute cognitive change and ensuring appropriate medical assessment.

Different settings need different roles in one connected pathway

In acute hospital care, the priority is prevention, early recognition, investigation of underlying causes and safe clinical management. Emergency, medical, surgical, orthopedic and intensive-care settings may all care for high-risk older people, although risk varies by population.

In rehabilitation or transitional care, recent or persistent delirium can affect mobility, participation, nutrition, communication and the ability to follow rehabilitation instructions. Cognitive status therefore needs to be interpreted alongside functional recovery rather than being treated as a separate issue.

At home, family members may be the first to notice that someone recently discharged is “not themselves.” They need clear advice about when an acute cognitive or behavioral change should prompt medical assessment, including urgent assessment when clinically indicated.

In primary and community care, health workers can identify change from baseline, review information from recent hospital care and direct the person toward appropriate clinical assessment. Community screening should not become an attempt to diagnose complex delirium without the necessary professional expertise.

In long-term care, staff may know a resident’s usual cognition and behavior better than an unfamiliar hospital team. A sudden change in alertness, appetite, mobility, communication or engagement should therefore trigger concern and appropriate assessment rather than automatically being attributed to dementia or “normal aging.”

Different settings have different responsibilities, but they share one principle:

an acute change from baseline deserves attention.

Measure whether delirium is prevented, recognized and acted on

A delirium quality program should not be judged only by how many delirium diagnoses appear in the medical record. A very low diagnosis rate might reflect successful prevention, but it could also mean delirium is being missed.

Organizations therefore need process and outcome measures that can be interpreted together. Illustrative measures might include documentation of baseline cognition in higher-risk older patients, delirium-risk assessment where appropriate, use of a validated assessment after acute cognitive change, time from change to clinical assessment, medication review, delivery of multicomponent prevention, delirium incidence in defined populations, relevant safety events during delirium, and whether the episode is clearly documented at transition or discharge.

Long-term-care and community services may appropriately focus more on recognizing acute change and escalating it promptly than on making the definitive diagnosis themselves. Patient and family experience also matters: were they told what delirium was, did they understand that symptoms may fluctuate, and did they know what to watch for after discharge?

These are illustrative quality measures, not a proposed national delirium indicator set for Viet Nam. The purpose is to determine whether an organization has a reliable system rather than simply adding another screening form.

Viet Nam could begin with focused implementation pilots rather than waiting for a national delirium program or for the future WHO guideline to be completed. A hospital might start with a defined high-risk population, such as older medical or geriatric inpatients, and establish a pathway that documents usual cognition and function, identifies risk, applies multicomponent prevention, watches for acute change, assesses promptly, investigates likely causes, reviews medication and communicates the episode at discharge.

Emergency and intensive-care services could adapt assessment to their own environments. Rehabilitation services could incorporate recent delirium into interpretation of participation and function. Long-term-care organizations could train staff to recognize acute changes from residents’ usual state and establish clear clinical escalation pathways.

A pilot should answer practical questions that matter in Viet Nam: Can staff reliably establish cognitive baseline? Who triggers assessment? Which prevention components can current workflows deliver consistently? Are hypoactive cases being missed? Are medication changes visible? Does the next care team know that delirium occurred? Do families understand what happened?

The National Geriatric Hospital study shows that Viet Nam already has clinical and research experience in delirium assessment. What remains limited is implementation evidence across different Vietnamese hospitals, community settings and long-term-care populations.

Delirium is ultimately a test of whether the system notices change

Delirium often begins with something deceptively simple: an older person is suddenly not thinking, behaving or functioning as they usually do.

A high-quality system notices that change. It does not assume that confusion is inevitable because someone is old, that a quiet patient is necessarily well, or that agitation should be controlled before asking why it is happening. It also does not forget the episode once the person leaves the ward.

WHO’s decision to develop its first global guideline on delirium in older adults reflects the importance of this problem. At the same time, Viet Nam’s expanding older-person care infrastructure already provides useful building blocks through cognitive assessment, recognition of transient confusion, medication review, family involvement and stronger home- and community-care pathways.

The next step is to connect those pieces around acute cognitive safety.

For healthcare and long-term-care organizations, the most useful question is therefore not simply, “Do we diagnose delirium?” It is:

“Can we recognize when an older person has changed from their usual state, reduce preventable risks, identify and treat possible causes promptly, manage the person safely, and make sure that information follows them to the next setting?”

When that question can be answered consistently, delirium care becomes more than the management of confusion. It becomes part of the infrastructure for safe, age-friendly and integrated older-person care.

References

1. World Health Organization. Call for Experts: WHO Guideline on the Prevention, Diagnosis and Management of Delirium in Older Adults (including Medication Safety and Deprescribing). 22 June 2026.

2. World Health Organization. Guideline Methodologist: WHO guideline on the prevention, diagnosis and management of delirium in older adults, including medication safety and deprescribing. 22 September 2026.

3. World Health Organization. Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. 2nd ed. Geneva: World Health Organization; 2025.

4. National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and management in hospital and long-term care. CG103. Updated 18 January 2023.

5. Wu CR, Chang KM, Tranyor V, Chiu HY. Global incidence and prevalence of delirium and its risk factors in medically hospitalized older patients: A systematic review and meta-analysis. International Journal of Nursing Studies. 2025;162:104959. doi:10.1016/j.ijnurstu.2024.104959.

6. Sánchez A, Sawant-Uttekar P, Heinen D, et al. Effectiveness of non-pharmacological and pharmacological interventions in preventing delirium in older adults: a systematic review and meta-analysis of randomised controlled trials. Age and Ageing. 2026;55(3):afag068. doi:10.1093/ageing/afag068.

7. Shaban M, Mohammed HH, Osman YM, Shaban MM. Nurse-Led Multicomponent Interventions for Delirium Prevention in Hospitalised Older Adults: A Systematic Review and Meta-Analysis. Journal of Advanced Nursing. 2026. doi:10.1111/jan.70706.

8. Nguyen Ngoc Tran, Hoang Thi Phuong Nam, Ho Thi Kim Thanh. Diagnosis and Risk Factors for Delirium in Elderly Patients in the Emergency Rooms and Intensive Care Unit of the National Geriatric Hospital Emergency Department: A Cross-Sectional Observational Study. International Journal of General Medicine. 2021;14:6505–6515. doi:10.2147/IJGM.S325365.

9. Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026.

10. Whitby J, Nitchingham A, Caplan G, Davis D, Tsui A. Persistent delirium in older hospital patients: an updated systematic review and meta-analysis. Delirium. 2022;1:36822. doi:10.56392/001c.36822.