Ramelteon may be effective for treating delirium in older hospitalized patients, according to the findings of a new study. There is currently no effective treatment for delirium, which can affect up to 30% of patients older than 65 years of age at some time during a hospitalization. In a small study, 67 patients ages 65-89 years who were newly admitted to the hospital for serious medical problems were randomized to ramelteon 8 mg per day or placebo every night for 7 nights. Ramelteon was associated with a lower risk of delirium (3% vs 32%; P = 0.003). Kaplan-Meier estimates of time to development of delirium were about a day longer with ramelteon (6.94 vs 5.74). The authors feel that ramelteon administered nightly to elderly patients admitted for acute care may provide protection against delirium. Since ramelteon is a melatonin agonist, these findings support possible pathogenic role of melatonin neurotransmission in delirium (JAMA 2015;313:1745-1746; doi:10.1001/jama.2014.17394).