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Change in mental status is a common symptom in the older, hospitalized patient. Often referred to as delirium, it may be the first indication of a serious medical condition. If delirium is not identified and treated promptly, it may lead to severe complications. The podiatric physician can prevent many cases of delirium by maintaining a high level of suspicion, performing a thorough clinical assessment, and identifying older patients at risk in the hospital setting. (J Am Podiatr Med Assoc 94(2): 118-125, 2004)