What are the non-pharmacological management strategies for delirium?

From the Guidelines

Non-pharmacological management of delirium should be the first-line approach before considering medications, as it has been shown to reduce delirium incidence and improve patient outcomes. The most effective strategies include maintaining orientation through frequent reorientation techniques, placing clocks and calendars in the patient's room, and ensuring familiar objects from home are present 1. Establish a consistent daily routine with a regular sleep-wake cycle, providing adequate lighting during the day and darkness at night to support circadian rhythms. Ensure sensory aids like glasses and hearing aids are available and functioning properly. Early mobilization is crucial - get patients out of bed when possible and engage in physical therapy appropriate to their condition. Maintain proper hydration and nutrition, monitoring intake and output carefully. Treat underlying causes such as pain, constipation, or urinary retention promptly. Create a calm environment by reducing unnecessary noise, avoiding room changes, and limiting the number of staff interactions. Family involvement can significantly reduce delirium severity, so encourage family presence and participation in care when possible. Cognitive stimulation through appropriate activities and conversation helps maintain mental function.

Key Components of Non-Pharmacological Management

• Regular postoperative delirium screening for patients over 65 years of age 1
• Non-pharmaceutical interventions such as regular orientation, sleep hygiene approaches, and cognitive stimulation to prevent delirium 1
• Minimizing medication triggers 1
• Multicomponent nonpharmacologic interventions that include strategies to reduce modifiable risk factors for delirium, improve cognition, and optimize sleep, mobility, hearing, and vision in critically ill adults 1

Implementation of Non-Pharmacological Management

• Provide a tailored intervention to meet each patient's needs 1
• Ensure high fidelity in the implementation of non-pharmacological management strategies 1
• Involve family members in the care and decision-making process to reduce delirium severity and improve patient outcomes 1

From the Research

Non-Pharmacological Management of Delirium

• Delirium is a common neurobehavioral complication in hospitalized patients that can occur in the acute phase and lead to poor long-term outcomes 2.
• Non-pharmacological interventions are thought to be important in delirium prevention, and multicomponent interventions have been shown to reduce the incidence of delirium in hospitalized adults 3, 4.
• These multicomponent interventions may include:
  • Re-orientation (including use of familiar objects)
  • Cognitive stimulation
  • Sleep hygiene
  • Attention to nutrition and hydration
  • Oxygenation
  • Medication review
  • Assessment of mood and bowel and bladder care
  • Reducing sensory deprivation
  • Identification of infection
  • Mobilisation
  • Pain control 3, 4, 5, 6
• The evidence suggests that non-pharmacological interventions can reduce the incidence of delirium, with a pooled risk ratio of 0.57 (95% CI 0.46 to 0.71) compared to usual care 3.
• There is also evidence to suggest that these interventions may reduce hospital length of stay, with a mean difference of -1.30 days (95% CI -2.56 to -0.04 days) compared to usual care 3.
• Non-pharmacological interventions are feasible and supported by ICU staff and patients' families, and should be considered in the care of the critically ill patient 5.
• The use of non-pharmacological nursing interventions, such as multicomponent intervention, multidisciplinary care, multimedia education, music listening, and mentoring of family caregivers, may also be effective in preventing and treating delirium in hospitalized adult patients 6.