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This study aimed to determine ED delirium prevalence, identify associated patient characteristics in a diverse population, describe current ED management practices, and examine hospital utilization outcomes in a large, heterogeneous cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multi-site retrospective cohort study analyzed 2,827 older adult patients (\u2265\u200965\u00a0years) across three diverse EDs within a single integrated health system in the New York metropolitan area, identifying delirium via rigorous, validated in-depth chart review requiring evidence of acute change from baseline. Independent risk factors for ED delirium and hospital admission were identified via modified Poisson regression. Management strategies and 30-day hospital utilization outcomes were characterized. All analyses were stratified by control and intervention periods of a parent delirium screening trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ED delirium prevalence was 16.0% (95% confidence interval: 14.6\u201317.4%), consistent across study periods and sites. The prevalence of delirium was 27.3% among hospitalized patients; 7.9% of all discharged patients had delirium. Independent risk factors included advanced age (adjusted relative risk, aRR\u2009=\u20091.01), dementia (aRR\u2009=\u20093.10), higher Charlson Comorbidity Index (aRR\u2009=\u20091.06), facility arrival (aRR\u2009=\u20091.28), and higher ED acuity (aRR\u2009=\u20093.85 for highest). Patients with delirium were more likely to receive physical restraints, psychoactive medications, and constant observation, but also safety precautions, family involvement, and palliative care consults (all p\u2009&lt;\u20090.001). Delirium independently predicted hospital admission (aRR\u2009=\u20091.54) and was associated with higher 30-day readmissions (19% vs. 13%; p\u2009=\u20090.002).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Approximately 1 in 6 older ED patients had delirium, including 7.9% who were discharged home. ED management involved both restrictive (restraints, psychoactive medications) and supportive (Goals-of-Care discussions, family involvement, safety precautions) strategies, though the latter remained underutilized. These findings underscore the critical need for standardized delirium screening, enhanced recognition, and supportive strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-026-10544-x","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T16:37:14Z","timestamp":1780418234000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Delirium in Older Adults Presenting to the Emergency Department: Prevalence, Risk Factors, Management Strategies, and Hospital Utilization Outcomes"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9700-251X","authenticated-orcid":false,"given":"Liron","family":"Sinvani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Perrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahidul","family":"Islam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Sison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefani","family":"Slotnick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Chua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Porreca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas P.","family":"Barnaby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Kwiatek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Cary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidhi","family":"Garg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payal","family":"Sud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Makhnevich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"issue":"4","key":"10544_CR1","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.jemermed.2019.05.024","volume":"57","author":"V Boucher","year":"2019","unstructured":"Boucher V, Lamontagne ME, Nadeau A, et al. 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