Prevention

Prevention of Delirium

Delirious patients often experience agitation, hallucinations, and a sharp decline in their attention and cognition. Patients age 70 and older are at greater risk for developing delirium, which is the most common acute disorder affecting hospitalized adults. It adds both extra time and extra cost to hospital stays plus immeasurable stress to the patient and their family members and is associated with a high hospital morality rate, as well as increased rates of institutional placement. .

Primary prevention of delirium is likely to be the most effective treatment strategy. The multifactorial nature of delirium suggests that intervention strategies targeting multiple known risk factors might be effective in preventing its occurrence in hospitalized older patients. The target safety problem is the primary prevention of delirium, rather than the treatment of existing delirium.

Practice recommendations to prevent delirium include the use of patient reorientation techniques such as verbal reassurance, re-introduction of team members, review of the daily hospital routine and patient schedule, environmental modifications and (visible clocks and calendars and scheduled patient mobility). Patients with cognitive impairment should receive daily orientation interventions and cognitive stimulation activities three times a day. Patients may also benefit from back massage and use relaxation tapes to promote sleep.

For bed bound and ambulatory patient’s daily exercise three times a day is beneficial. For patients with sensory impairment, visual aids, auditory amplifiers, and larger size push-button phones are beneficial. These multi component interventions can prevent incident delirium in hospitalized patients.

By Lucy Varghese - 2007