From the Guidelines
Preventing and managing hospital delirium in older patients requires a multifaceted approach focusing on non-pharmacological interventions first, followed by judicious use of medications when necessary, with the most effective strategy being early identification of at-risk patients and implementation of multicomponent interventions as recommended by the British Journal of Anaesthesia in 2021 1. The approach should include maintaining orientation, ensuring adequate sleep, promoting early mobility and physical activity, addressing sensory impairments, maintaining proper hydration and nutrition, and minimizing the use of physical restraints.
- Key strategies for prevention and management include:
- Implementing multicomponent non-pharmacologic interventions, such as mobilisation, orientation, physiotherapy, communication, and comprehensive geriatric review, as part of an interdisciplinary team approach for the entire hospitalisation period 1.
- Returning cognitive aids immediately after surgery, protecting sleep-wake cycles, and encouraging the presence of family and friends as soon as possible to provide reassurance and familiarity.
- Using a checklist to promote non-pharmacological interventions, which has been associated with risk reduction, and reducing unnecessary transfers of care, promoting noise reduction, sleep hygiene, and nutrition at a hospital level 1. Medication management is also crucial, with a focus on avoiding or minimizing high-risk medications, and using low-dose antipsychotics like haloperidol or quetiapine short-term with careful monitoring when pharmacological intervention is necessary.
- Staff education on delirium recognition and management ensures consistent care, and family involvement provides reassurance and familiarity, both of which are essential components of a comprehensive approach to preventing and managing hospital delirium in older patients, as supported by the Annals of Internal Medicine in 2011 1.
From the Research
Strategies for Preventing Hospital Delirium in Older Patients
- Multicomponent interventions are strongly recommended for preventing delirium in older patients, particularly in surgical or medical wards, as evidenced by studies 2, 3, 4, 5, 6.
- These interventions typically involve a combination of strategies, such as:
- Cognitive stimulation
- Sleep hygiene
- Re-orientation
- Attention to nutrition and hydration
- Oxygenation
- Medication review
- Assessment of mood and bowel and bladder care
- Single-component interventions, such as physical training, geriatric risk assessment, and reorientation protocol, may also be effective in preventing delirium, as suggested by studies 5, 6.
Managing Hospital Delirium in Older Patients
- Multicomponent interventions may be effective in reducing the duration and severity of delirium, although the evidence is limited and uncertain, as noted in studies 4, 5, 6.
- Non-pharmacological interventions, such as cognitive stimulation and sleep hygiene, may be beneficial in managing delirium, as suggested by study 6.
- Further research is needed to determine the most effective strategies for managing delirium in older patients, as emphasized by studies 2, 5, 6.
Key Findings
- Multicomponent interventions can reduce the incidence of delirium by 27-54%, as reported in studies 3, 4, 5.
- These interventions may also reduce the length of hospital stay and improve cognitive function, as suggested by studies 4, 5, 6.
- The effectiveness of non-pharmacological interventions for treating delirium is limited, and more evidence is needed to confirm their benefits, as noted in studies 2, 5, 6.