Alasdair MacLullich

Research

Delirium and geriatric medicine research

My research addresses the recognition, assessment and consequences of delirium, and how clinical care can better support recovery in later life.

Areas of research

Delirium recognition and assessment

Developing and evaluating practical ways to recognise delirium, including the 4AT, and studying attention and cognitive change during acute illness.

Delirium, dementia and mortality

Understanding the links between delirium, prior cognition, long-term cognitive impairment, dementia and mortality.

Implementation and care

Studying how assessment, multidisciplinary care and rehabilitation can improve care during and after an episode of delirium.

Acute geriatrics and hip fracture

Researching acute geriatric and orthogeriatric care, including delirium around hip fracture and the biology of acute illness.

Current programmes

I lead or contribute to work on acute illness and long-term cognitive decline, and on improving recovery after an episode of delirium through the RecoverED programme. Current projects and their outputs are maintained on the University of Edinburgh Research Explorer.

For a complete, current publication record, see Research Explorer, ORCID and Google Scholar.

Selected publications

  1. Penfold RS, MacRae C, Sampson EL, Davis DHJ, Anand A, Ely EW, Guthrie B, MacLullich AMJ. Delirium, long-term conditions, and incident dementia in older adults admitted to hospital for emergency care in Lothian, Scotland: a population-based cohort study. 2026. The Lancet Healthy Longevity.

    This population-based cohort study examined the association between delirium and incident dementia across the spectrum of long-term conditions.

  2. Penfold RS, Wilkinson T, Stirland LE, MacRae C, Russ TC, Shenkin SD, Vardy E, Anand A, Guthrie B, Sampson EL, MacLullich AMJ. Prevalence and outcomes of recorded dementia vary by data source: a population cohort study of 133,407 older adults. 2026. Age and Ageing.

    This study compared dementia recorded in different health data sources and assessed its association with mortality and hospital use.

  3. Sandeman DVE, Rodgers S, Tocher J, MacLullich AMJ. Delirium after cardiac surgery incidence and perioperative risk factors in a prospective cohort. 2026. Journal of Cardiothoracic Surgery.

    This prospective cohort study investigated the incidence of delirium after cardiac surgery and its perioperative risk factors.

  4. Penfold RS, Bowman E, Vardy ERLC, Sampson EL, Anand A, Guthrie B, MacLullich AMJ. Using scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75,221 older adult hospital admissions. 2025. Age and Ageing.

    This study examined how 4AT scores may help identify possible dementia in routine hospital data.

  5. Penfold RS, Farrow L, Hall AJ, Clement ND, Ward K, Donaldson L, Johansen A, Duckworth AD, Anand A, Hall DE, Guthrie B, MacLullich AMJ. Delirium on presentation with a hip fracture is associated with adverse outcomes: a multicentre observational study of 18,040 patients using national clinical registry data. 2025. The Bone & Joint Journal.

    This national registry study examined the association between delirium at presentation and outcomes after hip fracture.

  6. Penfold RS, Squires C, Angus A, Shenkin SD, Ibitoye T, Tieges Z, Neufeld KJ, Avelino-Silva TJ, Davis D, Anand A, Duckworth AD, Guthrie B, MacLullich AMJ. Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: a systematic review. 2024. Journal of the American Geriatrics Society.

    This systematic review assessed how delirium detection tools perform when used at scale in routine hospital care.

  7. Arnold E, Finucane AM, Taylor S, Spiller JA, O’Rourke S, Spenceley J, Carduff E, Tieges Z, MacLullich AMJ. The 4AT, a rapid delirium detection tool for use in hospice inpatient units: findings from a validation study. 2024. Palliative Medicine.

    This diagnostic study validated the 4AT for detecting delirium in hospice inpatients.

  8. Penfold RS, Hall AJ, Anand A, Clement ND, Duckworth AD, MacLullich AMJ. Delirium in hip fracture patients admitted from home during the COVID-19 pandemic is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation, and readmission to acute services. 2023. Bone & Joint Open.

    This national study examined the adverse outcomes associated with delirium in people admitted from home with hip fracture.

  9. MacLullich AMJ, Hosie A, Tieges Z, Davis DHJ. Three key areas in progressing delirium practice and knowledge: recognition and relief of distress, new directions in delirium epidemiology and developing better research assessments. 2022. Age and Ageing.

    This review set out priorities for improving delirium care, epidemiology and research assessment.

  10. Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, Slooter AJC, Ely EW. Delirium. 2020. Nature Reviews Disease Primers.

    This comprehensive primer reviewed the epidemiology, mechanisms, diagnosis, prevention, management and wider impact of delirium.