BACKGROUND: Gender differences have been reported in some common mental disorders. However, few studies have monitored gender differences in individuals with delirium. OBJECTIVE: To explore gender differences in challenging behaviors, management and outcomes in age-matched elderly patients with delirium.DESIGN, TIME AND SETTING: A retrospective cohort study was performed in the Bankstown-Lidcombe Hospital, Sydney, Australia, from October 2008 to April 2009. METHODS: Patients, aged 65-90 years, diagnosed with delirium according to the Intational Classification of Diseases (ICD)-10 in the Psychogeriatric Unit of Bankstown Lidcombe Hospital from January 2002 to October 2008 were reviewed. All the patients were measured according to the Confusion Assessment Method upon admission. Those who developed delirium during hospitalization were excluded.MAIN OUTCOME MEASURES: Cause of delirium, wandering, aggression, duration of delirium, physical restraint, use of antipsychotic medicine, recovery from delirium, discharge back home, length of stay, one-to-one nursing care, falls and absconding rate.RESULTS: The 131 age-matched delirious patients comprised 54 males and 77 females. The behavioral disorders of wandering [odds ration (OR) = 2.612, 95% confidence interval (CI) = 1.26 -5.413, P = 0.009] and aggression (OR = 2.243, 95% CI = 1.028 - 4.891, P= 0.04) were more frequent in males than in females. More males received one-to-one nursing care (OR = 4.114, 95% CI = 1.355 - 12.491, P = 0.008), were more likely to receive antipsychotic medications (OR = 2.24, 95% CI = 1.095-4.583, P = 0.021) and more likely to be physically restrained (OR = 2.07, 95% CI = 1.02-1.02, P = 0.043) compared with female patients. All absconding patients (3/131, 2.3%) were male. In addition, male patients displayed a greater falling rate compared with females (OR = 4.57, 95% CI= 1.519-13.722, P = 0.004).CONCLUSION: There are gender differences in challenging behaviors, management and outcomes in elderly delirious patients. Males with delirium display more challenging behaviors that require physical restraint and pharmacological management including wandering and aggression; males also abscond and have a higher rate of falls compared with female patients.