Assessing older adults in mental health
- Technique
In older adults, first rule out delirium and medical causes, then look for depression, dementia, medicines, abuse and isolation.
What it is
Mental health assessment in older adults looks for problems that present differently than in younger people. Acute confusion suggests delirium, which in older adults is often the first sign of another, sometimes serious, disorder; quiet, withdrawn delirium may be mistaken for depression; new psychosis late in life is unexpected at that age and calls for a medical search; and medicines, particularly anticholinergics and opioids, are common causes of delirium. The assessment adds cognition, carers’ information, abuse, alcohol use and loneliness to the usual psychiatric interview.
How it is done
- Ask the patient and a carer what has changed and whether it began over hours to days.
- Check attention and level of consciousness first; screen for delirium.
- Review all medicines, especially anticholinergics, opioids and benzodiazepines, and alcohol use.
- Assess mood and suicidal thoughts directly, and use a depression screening scale.
- Explore loneliness and social contact, carers’ support and possible abuse or neglect.
- Look for a medical cause of new or unexpected symptoms.
Delirium and dementia compared
| Feature | Delirium | Dementia |
|---|---|---|
| Onset | Hours to days | Slower |
| Course during the day | Fluctuates; may lessen during the day and worsen at night | No fluctuation over hours as the defining feature |
| Function mainly affected | Attention | Memory |
| Usual cause | Another disorder, medicines or withdrawal | Anatomic changes in the brain |
| Reversibility | Treat the underlying disorder and remove aggravating factors | Generally irreversible |
Clinical notes
- Delirium often develops in people with dementia (delirium superimposed on dementia), and people with delirium have a higher risk of later dementia and of cognitive decline for up to two years.
- New psychosis in an older adult is unexpected at that age and calls for a search for a medical cause, including delirium and medicines.
- Benzodiazepines are avoided in delirium except when it is caused by alcohol or benzodiazepine withdrawal.
Test yourself
Think of the answer, then tap the question to see it.
An 82-year-old becomes quiet, drowsy and withdrawn over two days after surgery. What must be excluded first?
Hypoactive delirium, which is often mistaken for depression; check attention and consciousness and look for the medical cause.
How does delirium differ from dementia?
Delirium starts over hours to days, fluctuates and mainly affects attention; dementia starts more slowly, mainly affects memory and is generally irreversible.
Which medicine groups commonly cause delirium in older adults?
Anticholinergics and opioids in particular, and also benzodiazepines.
What share of suicide deaths occurs in people aged 70 or over?
Around a sixth (16.6 %), so suicidal thoughts are asked about in every older adult assessed for mental health.
Elsewhere in DurgiPedia
- Comprehensive geriatric assessment: function, cognition, falls
- Decision-making capacity (competence) and how to assess it
- Law 1996 of 2019: legal capacity of adults with disability
- Nursing the older adult: functional assessment and geriatric syndromes
Connections
In Pharmacology1
Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.
Sources: Delirium (MSD Manual Professional Edition, 2025); Prevention of Psychosocial Problems in Older Adults (MSD Manual Professional Edition, 2025); Medical Assessment of the Patient With Psychiatric Symptoms (MSD Manual Professional Edition, 2024); Mental health of older adults (World Health Organization, 2026).
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Representative model, for educational purposes only.