Delirium and psychotropic deprescribing in very old inpatients: opportunities for safer prescribing in a medical ward

Delirium is a frequent and serious complication in very old hospitalized patients and is associated with increased morbidity, longer length of stay and worse functional outcomes. Exposure to psychotropic and anticholinergic drugs is a key modifiable risk factor, particularly in frail patients with multimorbidity and polypharmacy. This study aimed to describe prescribing and deprescribing practices of potentially deliriogenic psychotropic medications and to explore their relationship with delirium in patients aged ≥80 years admitted to a medical ward where geriatricians and internists share care.

We conducted a single‑center retrospective observational study including all patients aged ≥80 years admitted consecutively to the Internal Medicine ward of Hospital Ernest Lluch between November 2025 and February 2026. Sociodemographic data, comorbidity (Charlson index), baseline cognitive status, residence, responsible service (Geriatrics vs Internal Medicine), and exposure to benzodiazepines, Z‑hypnotics, antipsychotics, opioids and other drugs with high anticholinergic burden at admission and discharge were collected. Delirium was identified from clinical records and standardized tools, and descriptive and bivariate analyses were performed.

Included 288 patients (mean age 88.4 years), almost half with previous cognitive impairment; 40.8% delirium, predominantly hyperactive, and these patients showed a trend toward longer hospital stay. Overall in‑hospital mortality was 11.1%, without significant differences according to delirium or responsible service. At admission, 31.5% of patients were exposed to at least one deliriogenic drug, mainly benzodiazepines and atypical antipsychotics, and a relevant proportion remained exposed at discharge. Deprescribing intensity differed by specialty: geriatricians reduced the total number of drugs more frequently than internists, both in the overall cohort and in patients with delirium, without increasing in‑hospital mortality.

Very old inpatients remain highly exposed to potentially inappropriate, deliriogenic psychotropics, and hospitalization is only partially used as an opportunity for deprescribing, particularly in Internal Medicine. Implementing structured, geriatric‑oriented medication review protocols and shared psychogeriatric strategies may help reduce delirium risk and optimize outcomes in this population.