OET letter for a patient with dementia or delirium: how to describe cognition, capacity and family
In an OET Nursing letter about a patient with dementia or delirium, describe what the patient can and cannot do now in plain observable terms (orientation, memory, behaviour, daily activities), make clear whether the confusion is new or long-standing, and state who supports or makes decisions with the patient. Leave out labels and scores the reader cannot act on, and never write about the patient in a way that is disrespectful.
Why these cases need care
Older patients with dementia, delirium or both appear often in nursing case notes, especially in transfer letters to aged care and discharge letters to community teams. The notes usually contain a lot of behaviour detail: wandering at night, pulling at lines, refusing meals, calling out. Your job is to turn that into a clear, respectful picture the next carer can use on the first day.
Three questions guide the selection:
- Is the confusion new, long-standing, or both? The reader manages a new delirium very differently from stable dementia.
- What can the patient do safely, and what needs help? This is what the receiving nurse plans around.
- Who is involved? Family, carers and anyone with decision-making authority named in the notes.
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| The diagnosis or working diagnosis (dementia, delirium, or delirium on a background of dementia) | Long descriptions of how the diagnosis was made |
| The patient's usual level of function before admission | Every daily behaviour chart entry |
| What has changed, when, and the likely cause if stated (infection, new medicine, constipation) | Investigations that were normal and changed nothing |
| Current orientation, memory and communication, described in observable terms | Labels such as "difficult" or "demented" |
| Safety risks: falls, wandering, refusing medicines, swallowing problems | One-off events that resolved and have no ongoing effect |
| What calms or helps the patient (routine, a family member, a hearing aid) | Personal history that does not affect care |
| Family or carer arrangements and any concerns they raised | Family members who are not involved |
| What you want the reader to do (monitor, review, continue strategies) | A repeat of the full medication list if nothing changed |
Describing cognition in plain words
Assessors look at whether your letter is clear to the reader and written in an appropriate professional tone. Vague or judgemental wording fails on both. Compare:
| Avoid | Write instead |
|---|---|
| "She is very confused." | "She is disorientated to time and place but recognises her daughter." |
| "He is aggressive." | "He becomes agitated and has pushed staff away during personal care, particularly in the evening." |
| "Demented patient" | "Mr Lee, who has Alzheimer's disease" |
| "Wanders" | "He walks the corridors at night and has twice tried to leave the ward." |
| "Not compliant with meds" | "She sometimes refuses her tablets but usually accepts them when offered with food." |
| "Confusion ↑" | "Her confusion has increased over the past two days." |
Put the person first and describe behaviour, not character. For more on tone, see the Genre & Style guide, and for the general method of turning shorthand into sentences, see case notes to full sentences.
Showing the baseline: before and now
A letter about delirium is mostly about change. The reader needs a "before" and an "after":
- Before: "Before admission, Mrs Novak lived alone, managed her own medicines with a weekly pill organiser and walked to the local shop."
- Now: "Since developing a urinary tract infection, she has been drowsy during the day and restless at night, and she needs prompting to eat and drink."
- Trend: "Her alertness has improved since antibiotics were started, but she is not yet back to her usual level."
For established dementia without a new change, the baseline is the main point: describe what the patient usually manages and the routines that work.
Capacity, consent and family
Write only what the notes state. If the notes say a family member holds legal authority for health decisions, mention it, because the reader will need to involve that person. If the notes record that the patient's ability to make a particular decision was assessed, say what was decided and by whom. Do not add your own legal conclusions, and do not assume that a diagnosis of dementia means the patient cannot make any decisions.
Family concerns belong in the letter when the reader has to respond to them, for example "Her son is worried about her returning home alone and would like to discuss respite options."
Worked example (invented case)
Case summary (invented): Mrs Irena Novak, 84, retired seamstress, admitted 2 May with a urinary tract infection. Background: mild Alzheimer's disease diagnosed two years ago; previously lived alone, independent with personal care, used a weekly pill organiser, daughter visits daily. On admission: drowsy by day, agitated at night, disorientated to time and place, pulling at cannula. Treated with IV then oral antibiotics; cannula removed 5 May. Now alert by day, still disorientated to time, sleeps better since a night light was added and daughter visits each evening. Needs prompting with meals and supervision with showering. One near-fall 6 May when getting up at night; uses a walking frame. Daughter holds enduring power of attorney for health decisions. Cataract surgery 2015. Discharge to residential respite care 9 May for two weeks. Task: write to the nurse in charge at the respite facility.
Selection decisions:
- In: delirium cause and improvement, usual function before admission, current orientation, prompting and supervision needs, night-time strategies that work, near-fall and walking frame, daughter's role and authority.
- Out: cataract surgery, details of the IV antibiotic course now finished, cannula pulling (resolved).
Sample letter body:
Dear Nurse in Charge,
Re: Mrs Irena Novak, aged 84
I am writing to introduce Mrs Novak, who is being transferred to your facility today for two weeks of respite care after treatment for a urinary tract infection complicated by delirium.
Mrs Novak has mild Alzheimer's disease. Before admission on 2 May she lived alone and was independent with personal care and her medicines. During her admission she became drowsy by day and agitated at night. Since completing treatment, she is alert during the day, although she remains disorientated to time and is not yet back to her usual level.
She currently needs prompting to eat and supervision when showering. She walks with a frame and nearly fell when getting up at night on 6 May. She has slept better with a night light and when her daughter visits in the evening.
Her daughter, Ms Anna Novak, visits daily and holds enduring power of attorney for health decisions.
I would be grateful if you could monitor her orientation and night-time mobility, and continue the strategies above. Please contact me if you require further information.
Yours sincerely,
Notice that the letter never calls Mrs Novak "confused" without explaining what that means. Want feedback on a letter like this? Practise a timed case at /writing/ or check your own letter.
Mistakes to avoid
- No baseline. Without "before", the reader cannot judge improvement.
- Judgemental labels. "Difficult", "aggressive" or "demented" damage tone and say little.
- Copying the behaviour chart. Summarise the pattern; do not list every night.
- Forgetting what works. Strategies that settle the patient are among the most useful details for a new carer.
- Inventing legal status. Mention decision-making authority only when the notes state it.
See also the aged care transfer letter guide, mental health patient letters and common OET Writing mistakes.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical or legal advice; all patients and case notes are invented. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com. Rules on decision-making authority differ by country: check local guidance.