Which client is most at risk for developing delirium?

• A. A 50-year-old woman with cholecystitis
• B. A 19-year-old man with a fractured femur
• C. A 42-year-old woman having a elective hysterectomy
• D. A 78-year-old man admitted to the medical unit with complications related to congestive heart failure

Answer: (D)

Delirium risk rises when an older person faces acute illness or hospitalization, because aging reduces brain reserve and makes the brain more vulnerable to disturbances like infections, metabolic or electrolyte shifts, hypoxia, dehydration, and the effects of multiple medications. The 78-year-old man with congestive heart failure complications is at greatest risk because his advanced age combines with an acute, serious medical condition that can disrupt cerebral function through reduced blood flow, oxygenation, and fluid-electrolyte balance, plus the likelihood of polypharmacy and hospital-related factors. The younger individuals in the other scenarios have far fewer age-related vulnerabilities, so their delirium risk is comparatively lower.