To the Editor.
—While I am in wholehearted agreement with the important points Dr Portnoi emphasizes in her excellent review of the psychological consequences of physical illness in the aged published in the Archives (1981;141:734-737), I would like to emphasize that any temperature elevation in the aged can be associated with acute senile confusion both directly and indirectly. Considering only high fever as a basis for acute confusion fails to account for the fact that many elderly people are directly sensitive to even small temperature elevations (37 to 38° C) or that such seemingly negligible elevations may reflect more serious underlying disturbances (eg, sepsis or pulmonary emboli) at an early stage. Any temperature elevation in the aged, especially when associated with altered mental function, warrants careful investigation.Other causes of acute dementia, eg, fecal impaction and sudden urinary retention, were properly emphasized. Each of these conditions, however, is usually related