Treatment & Prevention of Delirium

Last updated on 17/11/2022

Managing delirium requires a multifaceted approach that includes both non-pharmacological (treatment methods that do not involve medication) and medical interventions. Addressing risk factors and providing appropriate care can help reduce the incidence and severity of delirium.

 

 

Non-Pharmacological Interventions

Non-pharmacological (non-medication-based) interventions used for the non-cognitive symptoms of dementia, such as agitation and confusion, can also help individuals with delirium. These strategies focus on creating a calm, structured environment to reduce distress and improve well-being.

By integrating these approaches into daily care, caregivers and healthcare providers can support those with delirium and enhance their comfort and security.

  1. Behavioural Interventions – Create a calm and structured environment with a routine, reassurance, minimised distractions, and familiar surroundings.
  2. Social Engagement – Reduce overwhelming interactions. Caregivers should speak clearly and calmly, and family involvement should be encouraged.
  3. Environmental Modifications – Ensure a safe and simple layout, clear signage, minimal clutter, and good lighting to reduce confusion.
  4. Caregiver Support – Provide training and resources for caregivers to improve communication, manage stress, and practice self-care.

 

 

Pharmacological Interventions

  1. Medications may be used short-term to relieve acute distress (following NICE Guidelines & National Clinical Guideline No. 21 ).
  2. However, since delirium is an acute medical emergency, the underlying cause must be identified and treated first.

 

 

Individualised Treatment Approaches

It’s important to note that treatment should be tailored to each individual and regularly reassessed to address changing needs. Consulting healthcare professionals with expertise in dementia care and delirium ensures the most effective strategies for managing symptoms.

 

 


Minimising Risk of Delirium

1. Promote Orientation

  1. Provide clocks, calendars, and windows with outside views.
  2. Verbally reorient the person to their surroundings.
  3. Encourage regular family visits.

 



2. Reduce Sensory Overload

  1. Avoid overstimulation, especially at night (e.g., loud noises, busy environments, frequent room changes).
  2. Ensure glasses and hearing aids are in use when needed.


3. Optimise Sleep

  1. Avoid interruptions at night (e.g., medication administration, medical procedures).
  2. Minimise nighttime noise and promote sleep hygiene.
  3. Be aware that some sleep medications may worsen delirium symptoms.


 

4. Address Medication-Related Risk Factors

  1. Certain medications can contribute to delirium, including:
    1. Benzodiazepines
    2. Narcotic analgesics
    3. Cardiac medications
    4. Anticholinergics
    5. Steroids

5. Full Medical Assessment

  1. Identify and treat underlying conditions that may be causing or worsening delirium.

**Seek urgent medical advice - untreated delirium can have serious or fatal consequences .**

 

 

Top Tips for Managing Delirium

**FULL MEDICAL ASSESSMENT IS THE MOST IMPORTANT STEP!**

Check the Environment

Stop and ask:

  1. Is there excessive noise (e.g., loud TV, staff handovers, meal time clatter)?
  2. Are pathways blocked by people, furniture or clutter, preventing safe movement?
  3. Are lights too bright or is there glare on the floor?
  4. Are mirrors positioned appropriately, or are they distressing?
  5. Is the temperature comfortable (not too hot or cold)?
  6. Have there been recent environmental changes (e.g., renovations, new staff, new residents)?
  7. Is there a safe space for movement and regulation?
  8. Does the environment support independence, dignity, and mobility?
  9. Are the person’s routines, habits, and preferences respected?

 

Assess Psychological Factors

Stop and ask:

  1. Does the person have a history of psychiatric illness?
  2. Have they experienced a recent loss or multiple losses?
  3. Do they appear sad, tearful, or withdrawn?
  4. Could past trauma be affecting current behaviour (e.g., post-traumatic stress)?
  5. Are they responding to hallucinations or delusions?

By implementing these strategies, caregivers and healthcare professionals can better support individuals experiencing delirium, helping them feel safer and more comfortable.