Preventing delirium in adults
If an adult is at risk of delirium, regularly monitor them for signs of delirium (ie changes in behaviour, cognition and physical condition) and instigate a multicomponent preventive strategy, personalised to their needs and setting. As appropriate, this strategy should include:
- treating medical conditions—see Risk factors for delirium in adults
- reviewing drugs for their potential benefit versus risk of harm—avoid using drugs that commonly cause or contribute to delirium and polypharmacy
- assessing pain and providing pain relief
- promoting healthy urinary and bowel function
- supporting and encouraging safe mobilisation, especially to the toilet
- providing adequate hydration and nutrition and, if needed, assistance with eating and drinking
- encouraging use of and ensuring access to glasses and hearing aids
- avoiding medical lines and tubes (eg catheters, drains), unless necessary; if used, remove them as soon as possible
- promoting good sleep practices
- providing lighting that approximates the time of day
- closely involving family, carers or significant others who can support the patient
- avoiding physical and chemical restraints
- using visual and auditory cues (eg providing an orientation board, a clock and a calendar) to orientate
- providing a quiet environment (eg a private room)
- avoiding movement between beds and wards
- encouraging cognition-stimulating activities (eg talking, reminiscing).
At the time of writing, there is insufficient evidence of benefit to recommend any drug (eg antipsychotics, melatonin, acetylcholinesterase inhibitors) to prevent delirium1.