Actually I lied. The patient was 85 years old. But the history is exactly the same. For some reason many doctors have a blind spot when it comes to older people. First, older people have a right to diagnosis the same as everyone else; second, they are physiologically different and present with medical problems in disguise; third, delirium is one of the most common and most under-recognised conditions in general medicine. It can linger long after the precipitating cause, in at least 20% of cases no cause is ever found, it has important prognostic implications, and it requires treatment in its own right.
My registrar argued that there was nothing she could do for this patient. I argued that she had missed an important geriatric syndrome - a medical diagnosis - and how easy it is to practice geriatric medicine badly.