Confusion, the mental state in which an individual is unable to think with complete clarity of mind, is characterized by a lack of awareness regarding the place, time or current circumstances. An individual who is afflicted with confusion is said to be confused. As an example, a confused person might not be able to recall that he is an inpatient resident at an extended care facility in New York, or that the current year is 2020.
Confusion is very much linked with the concepts of cognition and orientation. Cognition entails the various mental functions by which knowledge is acquired, retained and utilized: perception, learning, memory and thinking (Kihlstrom, 2018). Some healthcare workers use the terms cognition and mentation interchangeably. Orientation refers to a person's awareness of four specific elements: 1) self, 2) place, 3) time and 4) situation.
Clinicians such as physicians and nurses are trained to assess the orientation levels of their patients on a routine basis, normally as part of a mental status examination to determine cognition. When a person has full awareness of oneself, place, time and the current situation, she is described as "oriented times four" or "oriented x4," with the number four representing each of the four elements of orientation.
Orientation to self is the patient's ability to recall his or her own name, whereas orientation to place is the awareness or where he or she is. Orientation to time is the patient's ability to correctly recall the current time frame, including the day of the week, date, year and season. Finally, orientation to situation is the patient's ability to describe his or her current situation or circumstances in general terms.
Orientation to self is typically the last measure of orientation to be lost; this tends to take place in only the most profound cases of dementia. So, if a confused elder can recall her name and nothing more, clinicians refer to her as "oriented times one" or "oriented x1." A confused elder who recalls his name and the place correctly is said to be "oriented x2," and a patient who accurately states his name, the place and the time is "oriented x3."