Preventing delirium in palliative care
Patients with palliative care needs are often at risk of delirium; monitor for signs of delirium (ie changes in behaviour, cognition and physical condition) and instigate a multimodal preventive strategy, personalised to the patient’s needs, goals of care and setting. As appropriate, optimise management of predisposing and precipitating factors—see Risk factors for delirium in palliative care. Strategies may include:
- addressing hydration and nutritional needs
- reviewing drugs for their potential benefit versus risk of harm, including drugs that commonly cause or contribute to delirium
- assessing pain and managing pain
- assisting with personal care including urinary and bowel comfort
- supporting and encouraging safe mobilisation
- encouraging use of and ensuring access to glasses and hearing aids
- promoting good sleep practices—see Good sleep practices for adults in the Psychotropic guidelines
- providing lighting (including access to natural light) that approximates the time of day
- maintaining continuity and connection by closely involving people well known to the patient—limit staff changes if possible
- using visual and auditory cues to orientate the patient (eg providing an orientation board, a clock and a calendar)
- providing a peaceful, familiar environment (eg a private room with family photographs or known artwork hung on the wall, access to favourite music)
- encouraging cognition-stimulating activities (eg talking, reminiscing)
- avoiding physical and chemical restraints
- avoiding change of location (eg bed, room, ward)
- avoiding medical lines and tubes (eg catheters, drains), unless necessary; if used, regularly review continued need and assess for signs of infection.
At the time of writing, there is insufficient evidence of benefit to recommend any drug (eg antipsychotics, melatonin, acetylcholinesterase inhibitors) to prevent delirium1Bush, 2018.