From the Guidelines
The most appropriate measure to prevent delirium in this 87-year-old woman is early mobilization (option A). Early mobilization helps maintain physical function, cognitive orientation, and circadian rhythms, which are crucial for preventing delirium in hospitalized elderly patients. Getting patients out of bed and engaging in physical activity as soon as medically possible reduces the risk of complications associated with immobility and helps maintain normal sleep-wake cycles. The other options are less appropriate: haloperidol (option B) is an antipsychotic that may be used to treat delirium but is not recommended for prevention and can cause adverse effects in elderly patients; lorazepam (option C) is a benzodiazepine that can actually worsen confusion and precipitate delirium in older adults; and while melatonin (option D) may help with sleep regulation, it has less evidence supporting its use for delirium prevention compared to non-pharmacological approaches like early mobilization. The patient is already receiving appropriate interventions such as orientation, sensory aids, and sleep protection, but adding early mobilization would provide additional benefit in preventing delirium during her hospitalization, as supported by the National Institute for Health and Clinical Excellence guideline for prevention of delirium 1.
From the Research
Delirium Prevention Measures
The patient in question is an 87-year-old woman who has been hospitalized for sepsis related to pyelonephritis and is at risk for delirium due to her advanced age and medical history. To prevent delirium, several measures can be considered:
- Early mobilization: This approach has been shown to be effective in preventing delirium in critically ill patients 2, 3, 4, 5.
- Medication management: Reducing or titrating sedatives and opiate analgesics may also help prevent delirium 3, 5.
- Non-pharmacologic interventions: Strategies such as frequent orientation, providing glasses and hearing aids, and minimizing interruptions to nighttime sleep can also help prevent delirium 6.
Most Appropriate Measure
Based on the available evidence, the most appropriate measure to prevent delirium in this patient is:
- Early mobilization: This approach has been consistently shown to be effective in preventing delirium and improving patient outcomes 2, 3, 4, 5.
Comparison of Options
The other options are not supported by the evidence as the most effective measure to prevent delirium:
- Haloperidol: There is no evidence to suggest that haloperidol is effective in preventing delirium in this patient population.
- Lorazepam: This medication may actually contribute to delirium due to its sedative effects.
- Melatonin: While melatonin may be helpful in regulating sleep, there is no evidence to suggest that it is effective in preventing delirium in critically ill patients.
The correct answer is A: Early mobilization.