Objective To investigate the clinical features of elderly in-patients with delirium in the psychiatric consultations at general hospitals. Methods A total of 364 elderly in-patients (over 65 years old) from general hospitals who were diagnosed as delirium during the psychiatric consultation by our department during 2008 to 2011 were subjected in this study. Detailed clinical data of all subjects were retrospectively surveyed by self-made questionnaire for consultation reasons, primary physical diseases, and drug treatment after consultation, and then summarized and analyzed. Results The most common reasons for psychiatric consultation were disturbance of consciousness (55.2%) and verbal or behavioral confusion (24.6%). Medical conditions of these subjects were mainly neurological diseases (25.0%), post-operation (24.7%), cardiovascular diseases (22.5%) and respiratory diseases (19.2%). Neuroleptics were administered to 83.5% of the subjects, and they were olanzapine (46.2%), haloperidol (29.7%), quetiapine (5.2%), risperidone (3.8%) and benzodiazepines (3.8%). During the four years, the proportion of olanzapine was increased from 35.3% in 2008 to 56.9% in 2011 (P＜0.01), while that of haloperidol was decreased from 38.2% in 2008 to 19.3% in 2011 (P＜0.01). Conclusion Elderly in-patients are at high-risk of delirium, especially for those with cerebral infarction, infection or after surgery. More attention should be paid to these elderly patients.