A 70-year-old patient in a skilled nursing facility becomes confused and disoriented. The MOST likely cause is which condition?

• A. Urinary tract infection
• B. Myocardial infarction
• C. Irritable bowel syndrome
• D. Emphysema

Answer: (A)

In older adults, sudden confusion or disorientation is most often a sign of delirium triggered by an acute medical illness. Urinary tract infection is a common precipitant in nursing home residents because infection and the body's inflammatory response can rapidly affect brain function, leading to abrupt changes in attention and awareness. Notably, elderly patients may present with delirium as the primary symptom of a UTI, even if urinary symptoms are mild or absent. Risk factors in this setting—age, possible dehydration, catheter use, and underlying chronic diseases—make UTIs a frequent and reversible cause of acute confusion.

While a myocardial infarction can cause confusion through reduced brain perfusion, it typically presents with chest pain, dyspnea, or other cardiac signs. Irritable bowel syndrome and emphysema are less directly linked to an acute change in mental status in this scenario, making them less likely explanations for sudden confusion in a skilled nursing facility resident.