Delirium, the clinical expression of encephalopathy, is important in the context of COVID-19, because (a) delirium may be a symptom at presentation and/or during management, and (b) the behavioural changes commonly seen in delirium, particularly agitation, may make management including delivery of care and reducing the risk of cross-infection more challenging.

Older people are at the greatest risk from COVID-19. If infected they may present with or develop a delirium. However, delirium is not exclusive to older people and may well be seen in any patient with severe infection, adult respiratory distress syndrome, and those requiring invasive ventilation on ICU units.

Delirium, especially its hyperactive motor form, will present significant additional challenges in the context of the COVID-19 crisis. Standard non-pharmacological measures to treat or prevent delirium may well be not possible in isolation environments, and these environments may themselves worsen delirium.

This guidance should be used in parallel with the legal framework for the Adults with Incapacity Act (Scotland).