Jeannine Forrest and colleagues describe alarmingly poor outcomes associated with delirium, and highlight the commonly missed hypoalert-hypoactive delirium ("Recognizing Quiet Delirium," Reducing Risk, April). Since nurses frequently assess patients, they are in the best position to detect the emergence of delirium. In the Veterans' Administration's Delirium Working Group, nurse education plays an integral part. Given that delirium is often preventable and its effects minimized with timely intervention, mental status assessment of older adults is essential upon admission and routinely thereafter. Changes in mental status are meaningful only if there is a baseline for comparison. A simple instrument for assessing mental status, integrated into the routine nursing assessment, would improve the identification and thereby reduce the incidence and prevalence of delirium.

Editor-in-chief Diana J. Mason responds: See the article "Detecting Delirium" (page 50), part of AJN's How to Try This series, in this issue for more information on how to assess for delirium. A companion video is also available online at http://www.nursingcenter.com/

Marianne Shaughnessy, PhD, CRNP

Baltimore, MD