How do you weigh the risks and benefits of ongoing hospitalization in elderly patients with protracted delirium but without clear acutely reversible cause?

Even when no clearly reversible cause of delirium has been identified, clinicians should maintain a high index of suspicion for a missed diagnostic or therapeutic opportunity, recognizing that an initially "negative" evaluation may have overlooked factors such as polypharmacy, occult infection, uncontrolled pain, constipation, urinary retention, dehydration, metabolic disturbances, sleep disruption, or underlying neurologic disease. At the same time, it is important to recognize that continued hospitalization may itself contribute to or worsen delirium through sleep fragmentation, sensory deprivation, immobility, frequent interruptions, and an unfamiliar environment. If the patient is likely to benefit from additional hospital-level monitor...