Treatment Approach for Delirium

Comprehensive Assessment and Identification of Causes

The American College of Physicians recommends identifying predisposing and precipitating factors through a comprehensive initial assessment for patients with delirium 1
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, as suggested by the American College of Physicians 4
Address potentially reversible causes of delirium, such as treating infections, managing hypercalcemia with bisphosphonates, correcting hypomagnesemia with magnesium replacement, and discontinuing medications that may be contributing to delirium, as recommended by the American Society of Clinical Oncology 1, 4

Implement multicomponent interventions that include reorientation strategies, sleep improvement measures, early mobilization and rehabilitation, ensuring proper use of hearing aids and eyeglasses, maintaining adequate nutrition and hydration, minimizing unnecessary patient transfers within the hospital, infection control measures, and pain management, as suggested by the Society of Critical Care Medicine 2, 3, 4, 5
Provide educational and psychological support for families, including written information about delirium, as recommended by the American Society of Clinical Oncology 1

The Society of Critical Care Medicine recommends not routinely using antipsychotics or statins to treat delirium 2, 3
Consider short-term use of antipsychotics only for patients experiencing significant distress from hallucinations or delusions, agitation that may cause physical harm to themselves or others, and discontinue immediately following resolution of distressing symptoms, as suggested by the Society of Critical Care Medicine 3
For mechanically ventilated patients with agitation precluding weaning/extubation, consider dexmedetomidine, as recommended by the Society of Critical Care Medicine 2, 3

For cancer patients, olanzapine, quetiapine, or aripiprazole may offer benefit in symptomatic management of delirium, and methylphenidate may improve cognition in hypoactive delirium without delusions or perceptual disturbances, as suggested by the American Society of Clinical Oncology 1
For ICU patients, implement the ABCDEF bundle, and monitor for non-convulsive status epilepticus in high-risk patients, as recommended by the Society of Critical Care Medicine 3, 6

Ensure high fidelity in implementing multicomponent interventions, and provide interprofessional delirium education as a core component of hospital-wide strategy, as recommended by the American College of Physicians and the American Society of Clinical Oncology 1, 4, 5
Recognize that about one-third of delirium cases can be prevented through risk factor modification, as suggested by the American College of Physicians 4