From the Research
Management of prolonged delirium in the outpatient setting requires a comprehensive approach focusing on identifying and treating underlying causes while providing supportive care, with non-pharmacological interventions being the cornerstone of treatment, as evidenced by a 2021 study published in the Cochrane database of systematic reviews 1. The first step is to conduct a thorough medical evaluation to identify potential triggers such as medications, infections, metabolic disturbances, or organ dysfunction. Discontinuing any potentially deliriogenic medications, including anticholinergics, benzodiazepines, and opioids, when possible, is crucial. Some key points to consider in managing prolonged delirium in the outpatient setting include:
- Implementing non-pharmacological interventions, such as:
- Maintaining a consistent daily routine
- Ensuring adequate sleep
- Providing familiar objects
- Involving family caregivers
- Using orientation cues like calendars and clocks
- Considering pharmacological management with low-dose antipsychotics for severe symptoms, with options like haloperidol, risperidone, or quetiapine, but using them at the lowest effective dose for the shortest duration possible, typically 1-2 weeks with regular reassessment, as suggested by a 2013 study published in the Journal of palliative medicine 2.
- Ensuring regular follow-up appointments every 1-2 weeks initially to assess response and adjust treatment, and providing patient education about delirium, its fluctuating course, and the importance of environmental stability, as highlighted by a 2017 study published in Medizinische Klinik, Intensivmedizin und Notfallmedizin 3.
- Considering the use of non-pharmacologic interventions, such as early mobilization, earplugs and blinds at night, music and natural sunlight during the day, continuous reorientation, and increased visitation and family participation, as recommended by a 2021 study published in Nursing in critical care 4.
- Recognizing the importance of nursing staff education regarding the use of non-pharmacological management of delirium, as emphasized by a 2012 study published in the International journal of older people nursing 5.