A proposito di stati confusionali e contenzione nell’anziano - A rather high percentage of physical restraints for elderly people, especially in the nursing home setting, is due to the failure on the part of practitioners to identify delirium in clinical practice. This, in turn, leads to poor clinical management of the disorder, which may or may not be associated with dementia. After a brief description of the principal clinical features of delirium, this paper lists the main risk factors among the elderly, which are of a biological, iatrogenic (pharmacological) and socio-environmental nature. This text then goes on to discuss care strategies that are likely to prevent and/or improve delirium as well as strategies that are likely to worsen it (i.e. physical restraint). A correct approach to the problem actually requires a multidisciplinary view, one that is able to take into account the impact of several, only broadly clinical factors, which can play a very important role both at the pathogenetic and treatment level. Non pharmacological (or at least initially non pharmacological) strategies are less dangerous for patients, place more emphasis on the paramedical side of the treatment process (particularly nursing) and result in greater job satisfaction. Keywords: delirium, restraint, environmental strategies, psychogeriatrics, quality of care.