Management of Delirium in Long-Term Care Facilities

Introduction to Delirium Management

The American College of Physicians recommends immediately implementing a multicomponent nonpharmacologic intervention protocol while conducting a focused medical evaluation to identify and treat the underlying cause of delirium in long-term care facilities 1, 2

The Society of Critical Care Medicine suggests using the Confusion Assessment Method (CAM) to confirm delirium presence, which takes only 2-5 minutes and has the highest psychometric properties for detection 3, 4
Clinicians should look for the cardinal features of delirium: acute onset with fluctuating course, inattention, and either disorganized thinking or altered level of consciousness 5
The American Geriatrics Society recommends identifying and treating underlying medical causes of delirium, including medications, infections, metabolic derangements, alcohol or drug withdrawal, and pain 2, 5, 6

The American College of Physicians recommends implementing multicomponent nonpharmacologic interventions, including reorientation, environmental modifications, continuity of care, cognitive stimulation, mobilization, sensory optimization, hydration and nutrition, oxygenation, and sleep hygiene 1, 7, 8, 9
The Society of Critical Care Medicine suggests that approximately one-third of delirium cases can be prevented or reversed through risk-factor modification 1, 7

The American Psychiatric Association recommends avoiding antipsychotics and benzodiazepines for routine delirium treatment, particularly for hypoactive delirium 2
The Society of Critical Care Medicine suggests considering low-dose antipsychotics only for severely agitated patients with distressing psychotic symptoms, patients threatening substantial harm to themselves or others, or symptoms refractory to nonpharmacologic interventions 2, 5

The American Society of Addiction Medicine recommends initiating benzodiazepines within the first 6-24 hours to prevent progression to delirium tremens in patients with suspected alcohol withdrawal 6
The Society of Critical Care Medicine suggests providing thiamine supplementation to patients with alcohol use disorder 8

The American Geriatrics Society recommends reassessing mental status regularly using the CAM and adjusting interventions based on symptom control and patient distress 2, 8
The Society of Critical Care Medicine suggests providing educational support and written information about delirium to families 2
The American College of Physicians recommends recognizing that delirium is associated with increased mortality, prolonged hospitalization, and development of long-term cognitive impairment 4, 10