The term confusion describes a plethora of possible cognitive deficits and behavioral manifestations. A subjective assessment of confusion must be followed by an objective systematic evaluation to develop the cognitive-behavior profile. Because of age-associated physiologic and pathologic changes, elderly patients are at high risk for developing acute confusion. The management of confusion presents a challenge to nursing. Nursing can play a significant role in the prevention and the early detection of acute confusion. Preventing or identifying confusion early will decrease the physical and psychological stress of the patient as well as decrease the cost of hospitalization by shortening length of stay. Additional research is needed to determine the efficacy of present nursing activities and to identify new approaches for management.