Delirium Prevention and Management Guidelines

Introduction to Delirium Management

The American Geriatrics Society recommends that multicomponent nonpharmacologic interventions delivered by an interdisciplinary team should be the foundation of delirium prevention and management in at-risk patients 1, 2

Target high-risk groups for intervention, including persons aged 65 years or older, those with cognitive impairment or dementia, severe illness, and current hip fracture 3
Use standardized tools like the Confusion Assessment Method (CAM) or CAM-ICU for detection and monitoring of delirium 4
Perform a comprehensive medical evaluation to identify and manage underlying contributors to delirium 1, 2

Address cognitive impairment/disorientation through regular reorientation of the patient, ensuring adequate lighting and clear signage, providing visible clock and calendar, and minimizing room changes and maintaining care team consistency 4, 5, 6
Manage physical factors by ensuring adequate hydration and nutrition, addressing hypoxia and optimizing oxygenation, treating infections promptly, promoting early mobilization and rehabilitation, ensuring proper use of hearing aids and eyeglasses, and managing pain effectively, preferably with nonopioid medications 1, 2, 3, 5, 6
Implement sleep hygiene measures by reducing noise and interruptions during sleep hours and maintaining normal day-night cycles 3, 4

Continue multicomponent nonpharmacologic interventions when delirium is diagnosed 1, 2
Provide educational and psychological support for families, including written information about delirium 3, 4
Medications with high risk for precipitating delirium should be avoided 1, 2
Antipsychotics and benzodiazepines should be avoided for treatment of hypoactive delirium 1, 2
For severely agitated or distressed patients, or those threatening substantial harm to self/others, consider antipsychotics at the lowest effective dose for the shortest possible duration 1, 2

Optimize pain management, preferably with nonopioid medications 1, 2
Consider regional anesthetic at the time of surgery and postoperatively to improve pain control 1, 2

Regularly reassess mental status using standardized tools 4
Monitor for medication side effects, particularly extrapyramidal symptoms with antipsychotics 4
Adjust treatment approaches based on symptom control and patient distress 4

About one-third of delirium cases can be prevented through risk factor modification 6, 7
Delirium prevention is a cost-effective strategy that reduces cost and improves health outcomes compared with usual care 6, 7