An older adult in a skilled nursing facility develops acute confusion and agitation. The nurse recognizes which of the following factors as the most likely contributor to delirium?

Rationale: A. Alzheimer’s disease is a chronic neurodegenerative condition causing gradual cognitive decline. While it increases baseline vulnerability to delirium, the acute onset of confusion and agitation is more indicative of a precipitating factor rather than the slow progression of dementia itself. Chronic cognitive decline alone does not cause sudden delirium. B. Seasonal allergies are unlikely to precipitate acute delirium. They may cause mild discomfort, fatigue, or congestion, but they do not typically trigger sudden changes in cognition or behavior. C. Sensory deficits (hearing or vision loss) increase vulnerability to delirium by reducing environmental cues, but gradual decline is a long-term risk factor, not an immediate cause of acute delirium. It contributes to susceptibility but does not directly precipitate the sudden episode. D. Delirium is often triggered by acute physiological stressors or medication changes. Abrupt withdrawal from sedative medications, such as benzodiazepines or barbiturates, can cause CNS hyperexcitability, agitation, and acute confusion, particularly in older adults with decreased physiological reserve. This makes it the most likely immediate precipitating factor in this scenario