Delirium Management Guidelines

Diagnosis and Assessment

The American College of Physicians recommends that diagnosis should be made by a trained healthcare professional using clinical assessment based on DSM or ICD criteria 3
The American College of Physicians suggests assessing the patient for clinical factors contributing to delirium within 24 hours of hospitalization 1
Standardized tools like the Confusion Assessment Method (CAM) or CAM-ICU should be used for detection and monitoring, as recommended by the American Geriatrics Society 2

The American College of Physicians recommends searching for and addressing reversible causes of delirium, including medications, pain, dehydration, and constipation 1, 4

The American College of Physicians recommends ensuring continuity of care by having the patient cared for by a familiar team of healthcare professionals, and avoiding moving patients between rooms or wards unless absolutely necessary 1
The American College of Physicians suggests addressing cognitive impairment or disorientation by providing appropriate lighting and clear signage, ensuring a clock and calendar are easily visible, talking to the patient to reorient them, introducing cognitively stimulating activities, and facilitating regular visits from family and friends 1
The American College of Physicians recommends addressing dehydration by ensuring adequate fluid intake 4
The American Academy of Sleep Medicine suggests implementing sleep hygiene measures to promote normal sleep-wake cycles, as recommended by the American Geriatrics Society 2

The American Society of Clinical Oncology recommends that pharmacological interventions should be limited to patients who have distressing delirium symptoms or if there are safety concerns 5
The American Society of Clinical Oncology suggests avoiding haloperidol and risperidone as they have not demonstrated benefit in mild-to-moderate delirium and may worsen symptoms 5, 2
For moderate delirium symptoms requiring medication, the American Society of Clinical Oncology recommends considering olanzapine, quetiapine, or aripiprazole 5, 6

The American Academy of Hospice and Palliative Medicine recommends providing written information about delirium to family members, including definition, causes, symptoms, evolution, and management, as well as guidance on appropriate responses and non-pharmacological interventions 7, 6
The American Academy of Hospice and Palliative Medicine suggests supplementing written information with educational and psychological support for families, and offering debriefing opportunities for patients who recover from delirium episodes 7, 8

The American Geriatrics Society recommends regularly reassessing the patient's mental status using standardized tools, and adjusting treatment approaches based on symptom control and patient distress 2

The American Academy of Hospice and Palliative Medicine notes that hypoactive delirium is often underdiagnosed due to its less obvious presentation, and recommends focusing on symptom management and family support for delirium in patients with advanced disease and limited life expectancy 2