Materiały źródłowe

• #1 Delirium in elderly adults: diagnosis, prevention and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3065676/

  An estimated 30-40% of cases of delirium are preventable, and prevention is the most effective strategy for minimizing the occurrence of delirium and its adverse outcomes. […] The Hospital elder life Program (HELP) is an innovative strategy of hospital care for elderly patients that uses tested delirium prevention strategies to improve overall quality of hospital care. […] In a controlled trial that evaluated HELP, delirium developed in 9.9% of the intervention group, compared with 15.0% of the usual-care group (matched odds ratio 0.60, 95% CI 0.39-0.92). […] Proactive geriatric consultation has been found to reduce the risk of delirium following acute hip fracture by 40%. […] Other controlled trials testing delirium interventions found that multifactorial interventions or educational strategies targeted towards health-care staff can reduce delirium rates and/or duration.

• #2 Recognising and preventing delirium | Quick guides to social care topics | Social care | NICE Communities | About | NICE

  https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/recognising-and-preventing-delirium

  Delirium is preventable in 30% of cases. […] To help prevent delirium in anyone at risk: Make sure support is provided by carers who are familiar to them. […] Avoid moving the person unnecessarily, and keep their surroundings familiar. […] Request a review if they are taking multiple medications. […] Check on admission, and then daily, for any changes that might indicate delirium and refer for an assessment if needed. […] Factors that make delirium more likely are listed below, with steps to help reduce the risk. […] Encourage the person to drink. […] Support the person to avoid or address constipation. […] Make sure pain is well-managed. […] Look for signs of infection. […] Avoid using a catheter as far as possible. […] Make sure any dentures are clean, being worn and fit well. […] Avoid disturbing the person during sleep periods.

• #3 Delirium | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/delirium

  Delirium can often be prevented and can be treated and managed. As clinicians we must listen to the families of our patients when they tell us the person seems confused. […] Delirium is preventable in 30-40 per cent of cases. […] There are many things we can do to help older people and their families and carers understand, prevent and manage delirium. Here are some recommendations. […] Reducing, ceasing or avoiding the use of psychoactive drugs is recommended as they may worsen the delirium. […] Pharmacological therapy should only be considered in severe cases of behavioural or emotional disturbance because there is no strong evidence they effectively improve prognosis. […] Always document the indications for using and stopping use of antipsychotic medication in the patients medical history.

• #4 Preventing and treating delirium in clinical settings for older adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10493062/

  Prevention of delirium is most often accomplished by identifying and addressing the many vulnerabilities that increase risk for delirium. […] Prevention strategies can be divided into both nonpharmacological and pharmacological interventions, and several multi-component nonpharmacological approaches to delirium management focus on prevention. […] The most well studied are the Hospital Elder Life Program (HELP) and the ABCDEF bundle. […] A 2015 meta-analysis found that 11 studies with 4267 patients demonstrated that multi-component nonpharmacological delirium interventions reduced delirium incidence (odds ratio: 0.47; 95% CI: 0.380.58) with a number needed to treat of 14.3 (95% CI: 11.120.0). […] In contrast to the success of nonpharmacological approaches, pharmacological interventions have proven less helpful in preventing delirium. […] Despite the significance of delirium, there are few proven strategies for treatment once it develops, and thus interventions aimed at prevention should be prioritized.

• #5 Delirium and acute confusional states: Prevention, treatment, and prognosis – UpToDate

  https://www.uptodate.com/contents/delirium-and-acute-confusional-states-prevention-treatment-and-prognosis

  Delirium and acute confusional states: Prevention, treatment, and prognosis […] The preponderance of evidence is most compelling for primary prevention of delirium using nonpharmacologic, multicomponent approaches targeted broadly at high-risk patients. […] Prevention and therapy of delirium are based on the following principles: […] Avoiding factors known to cause or aggravate delirium, such as multiple medications, dehydration, immobilization, sensory impairment, and disruption of the sleep-wake cycle. […] Identifying and treating the underlying acute illness.

• #6 Delirium in elderly adults: diagnosis, prevention and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3065676/

  An estimated 30-40% of cases of delirium are preventable, and prevention is the most effective strategy for minimizing the occurrence of delirium and its adverse outcomes. […] The Hospital elder life Program (HELP) is an innovative strategy of hospital care for elderly patients that uses tested delirium prevention strategies to improve overall quality of hospital care. […] In a controlled trial that evaluated HELP, delirium developed in 9.9% of the intervention group, compared with 15.0% of the usual-care group (matched odds ratio 0.60, 95% CI 0.39-0.92). […] Proactive geriatric consultation has been found to reduce the risk of delirium following acute hip fracture by 40%. […] Other controlled trials testing delirium interventions found that multifactorial interventions or educational strategies targeted towards health-care staff can reduce delirium rates and/or duration.

• #7 Preventing and treating delirium in clinical settings for older adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10493062/

  Prevention of delirium is most often accomplished by identifying and addressing the many vulnerabilities that increase risk for delirium. […] Prevention strategies can be divided into both nonpharmacological and pharmacological interventions, and several multi-component nonpharmacological approaches to delirium management focus on prevention. […] The most well studied are the Hospital Elder Life Program (HELP) and the ABCDEF bundle. […] A 2015 meta-analysis found that 11 studies with 4267 patients demonstrated that multi-component nonpharmacological delirium interventions reduced delirium incidence (odds ratio: 0.47; 95% CI: 0.380.58) with a number needed to treat of 14.3 (95% CI: 11.120.0). […] In contrast to the success of nonpharmacological approaches, pharmacological interventions have proven less helpful in preventing delirium. […] Despite the significance of delirium, there are few proven strategies for treatment once it develops, and thus interventions aimed at prevention should be prioritized.

• #8 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Delirium is often preventable, but most preventive measures are things only clinical personnel should do. However, family, friends and loved ones can play a very important role in reducing the risk of delirium. […] Here are some methods that healthcare providers use to prevent delirium: Regular delirium assessments: Rounding and tracking mental state can help providers catch subtle warning signs that mean delirium could develop. Make natural lighting a priority. Using natural light during the daytime and providing enough darkness at night help your bodys natural timing stay accurate. Staying oriented to the time of day can be a big help in preventing delirium. Use glasses and hearing aids. Vision and hearing problems can increase the risk of developing delirium or make it worse. Eyeglasses and hearing aids can help your brain process information about the world around you. Early mobility is key. People who move around early in treatment (with medical guidance) had a lower risk of developing delirium in large clinical trials.

• #9 Delirium and acute confusional states: Prevention, treatment, and prognosis – UpToDate

  https://www.uptodate.com/contents/delirium-and-acute-confusional-states-prevention-treatment-and-prognosis

  Delirium and acute confusional states: Prevention, treatment, and prognosis […] The preponderance of evidence is most compelling for primary prevention of delirium using nonpharmacologic, multicomponent approaches targeted broadly at high-risk patients. […] Prevention and therapy of delirium are based on the following principles: […] Avoiding factors known to cause or aggravate delirium, such as multiple medications, dehydration, immobilization, sensory impairment, and disruption of the sleep-wake cycle. […] Identifying and treating the underlying acute illness.

• #10 Evaluation and Management of Delirium in Hospitalized Older Patients | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1201/p1265.html

  Delirium is common in hospitalized older patients and may be a symptom of a medical emergency, such as hypoxia or hypoglycemia. […] Interventions that have been shown to reduce the incidence of delirium in at-risk hospitalized patients include repeated reorientation of the patient to person and place, promotion of good sleep hygiene, early mobilization, correction of dehydration, and the minimization of unnecessary noise and stimuli. […] Addressing six risk factors (i.e., cognitive impairment, sleep deprivation, dehydration, immobility, vision impairment, and hearing impairment) in at-risk hospitalized patients can reduce the incidence of delirium by 33 percent. […] Hospital staff educational programs have been shown to effectively reduce delirium duration and related mortality. […] The optimal treatment of delirium involves primary prevention, which includes the reduction of modifiable risk factors.

• #11 Ask the Expert: Prevention and Treatment of Post-Operative Delirium | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/ask-expert-prevention-and-treatment-post-operative-delirium

  Delirium is a term meaning sudden confusion. It refers to a sudden change in mental function. Delirium can cause people to be either aggressive and agitated, or sleepy and inactive or sometimes a combination of both. […] Studies have shown delirium is preventable up to 40% of the time for older adults in the hospital. Some causes of delirium can be managed so they do not happen or get worse. […] There are some steps healthcare providers can take to help prevent post-operative delirium. The American Geriatrics Society Clinical Guideline for Post-Operative Delirium recommends the following. […] Prescribe prevention plans with multiple parts, such as: Having the patient walk multiple times daily, Orienting the patient to their location and the time multiple times daily, Allowing overnight sleep without disruptions or waking patient up, Making sure the older person gets enough fluid to avoid dehydration, Preventing infection, Avoiding use of internal bladder catheters and physical restraints, Making sure the older person has their glasses and/or hearing aids.

• #12 Delirium – Wikipedia

  https://en.wikipedia.org/wiki/Delirium

  In 1999, Sharon K. Inouye at Yale University, founded the Hospital Elder Life Program (HELP) which has since become recognized as a proven model for preventing delirium. […] HELP prevents delirium among the elderly through active participation and engagement with these individuals. […] Prevention efforts often fall on caregivers. […] Delirium may be prevented and treated by using non-pharmacologic approaches focused on risk factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep disturbance, functional decline, and by removing or minimizing problematic medications. […] Research into pharmacologic prevention and treatment is weak and insufficient to make proper recommendations. […] Avoidance or cautious use of benzodiazepines has been recommended for reducing the risk of delirium in critically ill individuals.

• #13 Preventing and treating delirium in clinical settings for older adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10493062/

  Prevention of delirium is most often accomplished by identifying and addressing the many vulnerabilities that increase risk for delirium. […] Prevention strategies can be divided into both nonpharmacological and pharmacological interventions, and several multi-component nonpharmacological approaches to delirium management focus on prevention. […] The most well studied are the Hospital Elder Life Program (HELP) and the ABCDEF bundle. […] A 2015 meta-analysis found that 11 studies with 4267 patients demonstrated that multi-component nonpharmacological delirium interventions reduced delirium incidence (odds ratio: 0.47; 95% CI: 0.380.58) with a number needed to treat of 14.3 (95% CI: 11.120.0). […] In contrast to the success of nonpharmacological approaches, pharmacological interventions have proven less helpful in preventing delirium. […] Despite the significance of delirium, there are few proven strategies for treatment once it develops, and thus interventions aimed at prevention should be prioritized.

• #14 Delirium in elderly adults: diagnosis, prevention and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3065676/

  A recent controlled trial also found that home rehabilitation after acute hospitalization in elderly individuals was associated with a lower risk of delirium, and greater patient satisfaction, when compared with the inpatient hospital setting. […] Recent studies have examined the role of pharmacological strategies in delirium prophylaxis. […] Haloperidol has been shown to reduce the incidence of delirium in a small group of patients who underwent surgery. […] This reduction in incidence was not confirmed statistically in a larger study, but haloperidol did reduce the severity and duration of delirium and length of hospital stay in some patients without causing notable adverse effects. […] Owing to methodological limitations and small sample sizes, these results need to be confirmed before haloperidol can be recommended for routine prophylaxis.

• #15 Delirium in elderly adults: diagnosis, prevention and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3065676/

  The few randomized, controlled clinical trials of cholinesterase inhibitors that have been performed to date have shown no benefit for these drugs in the prevention of postoperative delirium, but these studies were small and underpowered. […] Several case reports and one open-label study have suggested promising results with this approach, but additional randomized, controlled studies of cholinesterase inhibitors in acute medical and critical care populations, as well as the use of these drugs in combination with antipsychotics, are warranted before any definitive recommendations can be made. […] Other strategies that minimize the use of opioids or benzodiazepines through the use of alternative agents such as gabapentin or dexmedetomidine are under investigation for their capacity to reduce the incidence of delirium.

• #16 Delirium | AMBOSS Rotation Prep

  https://resident360.amboss.com/adult-medicine/geriatrics/delirium/delirium.html

  The key to managing delirium is prevention, followed by prompt recognition, evaluation of the underlying risk factors, and implementation of nonpharmacologic interventions. […] A multifaceted multidisciplinary prevention intervention reduced postoperative delirium in older patients undergoing elective surgical procedures but not cardiac procedures. […] In this systematic review, the authors found no evidence for the use of antipsychotics for the prevention of delirium in adult hospitalized patients.

• #17 Delirium in elderly adults: diagnosis, prevention and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3065676/

  The few randomized, controlled clinical trials of cholinesterase inhibitors that have been performed to date have shown no benefit for these drugs in the prevention of postoperative delirium, but these studies were small and underpowered. […] Several case reports and one open-label study have suggested promising results with this approach, but additional randomized, controlled studies of cholinesterase inhibitors in acute medical and critical care populations, as well as the use of these drugs in combination with antipsychotics, are warranted before any definitive recommendations can be made. […] Other strategies that minimize the use of opioids or benzodiazepines through the use of alternative agents such as gabapentin or dexmedetomidine are under investigation for their capacity to reduce the incidence of delirium.

• #18 Low-dose sedative reduces sudden confusion after major surgery in older adults

  https://evidence.nihr.ac.uk/alert/low-dose-sedative-reduces-sudden-confusion-after-major-surgery-in-older-adults/

  Giving a low-dose sedative to older adults in intensive care after surgery reduces sudden confusion, also known as delirium, without increasing the risk of adverse effects. […] Delirium is common after major surgery and in the intensive care setting, especially in older people. […] A safe treatment that reduces risk of delirium after surgery and the time spent in intensive care by older adults could be better for patients and cost saving for the NHS. […] The ideal aim would be to reduce the risk of delirium developing, for example by controlling temperature and infection. […] Dexmedetomidine reduced risk of delirium after surgery. […] This study shows promise as one intervention that could reduce delirium in this at-risk patient group, without apparently increasing risk of heart and vascular complications. […] Using a sedative drug should not replace the need for good post-operative care to remove any treatable cause for delirium. […] Preventative measures include preventing infection and dehydration, reducing confusion and helping people stay orientated.

• #19 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Loved ones can play a significant role in preventing and addressing delirium for someone in a medical setting. The goal is to keep your loved one engaged and anchored to the world around them. […] Social interactions with family, friends and other loved ones can be a major help in preventing delirium.

• #20 Tip Sheet: Managing Delirium in Older Adults | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/tip-sheet-managing-delirium-older-adults

  Family members and friends can play a key role in recognizing and preventing delirium. Heres how. […] Since you know the older person best, you can quickly pick up on changes in their mental state. Tell the healthcare staff right away if you notice anything unusual. […] In addition to the above steps, delirium can often be reversed by treating some of the common causes. You can discuss these with the older persons healthcare providers.

• #21 Hospital Delirium: Symptoms, Treatment, and Recovery

  https://www.healthline.com/health/hospital-delirium

  Researchers estimate that almost 40% of cases of hospital delirium are preventable. Theres much that hospital staff can do to help prevent delirium. But caregivers can also play an important role. […] Hospital staff can help create an environment that can reduce the risk. They may consider the following: Keep nighttime noise and light to a minimum. Schedule rounds to avoid disrupting sleep. Avoid using physical restraints if possible. Avoid using indwelling catheters if possible. Allow family members to stay overnight. […] Preventing hospital delirium can be a challenge for caregivers. Certain aspects of the hospital environment and the care provided are beyond your control. […] There are still ways in which you can help your loved one: Initiate conversations with them. Orient them after a medical procedure such as surgery. Help them get up and walk around when possible. Make sure they have their personal items, such as hearing aids or glasses. Encourage proper nutrition and hydration. Make sure theyre getting enough sleep. […] Know that, as a familiar presence in an unfamiliar setting, youre already reducing your loved ones risk of hospital delirium.

• #22 Alzheimer’s Disease and Delirium: Guidance and Tips

  https://www.webmd.com/alzheimers/confusion-delirium

  You can do some things to help make it less likely that your loved one will have delirium: […] Help them stay as healthy as possible and have good eating and sleeping habits. […] Remind them to drink plenty of fluids, and help them get exercise every day. […] Make sure they have their eyesight and hearing checked regularly. […] Try to stay away from medications, especially ones that can cause sleepiness or confusion, such as tranquilizers, narcotic pain medications, and sleeping pills. If medication has to be used, such as for pain, ask a doctor about using short-acting ones in lower doses. […] If your loved ones in a new place, such as a hospital, have someone who knows them stay with them at all times.

• #23 Delirium disrupts patients’ lives, but it may be prevented – Sanford Health News

  https://news.sanfordhealth.org/behavioral-health/preventing-delirium-hospital-confusion/

  Delirium disrupts patients’ lives, but it may be prevented. […] Delirium is common, but it isn’t always inevitable — and that’s why Dr. Pribula puts a lot of thought into how he might be able to help prevent it in the patients he admits to the hospital. […] Delirium prevention measures […] Some of the techniques health care workers can use to prevent delirium involve normalizing days and nights in a setting where people are coming and going at all hours and hallway lights never turn off. […] So they try to continually orient patients. […] Some patients, especially older adults, might take melatonin supplements to help encourage sleep at a normal time. […] Immediately, delirium prevention measures are started. […] For less severely ill COVID-19 patients, delirium prevention measures are similar to those for non-COVID-19 patients, he added. […] Families can become a useful partner in dealing with delirium by being that reassuring presence there for their loved one, when they’re able to. […] That’s why Dr. Pribula and other health care providers try so hard to help prevent it.

• #24 Delirium – Wikipedia

  https://en.wikipedia.org/wiki/Delirium

  In 1999, Sharon K. Inouye at Yale University, founded the Hospital Elder Life Program (HELP) which has since become recognized as a proven model for preventing delirium. […] HELP prevents delirium among the elderly through active participation and engagement with these individuals. […] Prevention efforts often fall on caregivers. […] Delirium may be prevented and treated by using non-pharmacologic approaches focused on risk factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep disturbance, functional decline, and by removing or minimizing problematic medications. […] Research into pharmacologic prevention and treatment is weak and insufficient to make proper recommendations. […] Avoidance or cautious use of benzodiazepines has been recommended for reducing the risk of delirium in critically ill individuals.

• #25 Delirium in Older Persons: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0801/p150.html

  Assessment for and prevention of delirium should occur at admission to the hospital and throughout the stay. […] Prevention efforts targeting persons at risk may decrease delirium incidence, hospital costs, and associated poor outcomes. […] Studies have demonstrated that a multicomponent nonpharmacologic approach is highly effective and reduces the number and duration of episodes of delirium. […] One such intervention, known as the Hospital Elder Life Program, is available at http://www.hospitalelderlifeprogram.org. This intervention has been shown to reduce the number of patients with functional decline and placement in long-term care facilities. […] Inpatient consultation focusing on geriatric syndromes has also been shown to decrease delirium incidence. […] Nonpharmacologic prevention strategies consist of orientation and therapeutic activities, early and recurrent mobilization, minimizing the use of psychoactive medications, promoting normal sleep-wake cycles, providing easy access to adaptive equipment for sensory impairment (e.g., glasses, hearing aids), and preventing dehydration. […] All caretakers should be educated on preventive approaches and encouraged to implement them. […] The Hospital Elder Life Program has also developed the Family Confusion Assessment Method, a validated screening tool that can be used by trained family members to detect delirium.

• #26 Home – Delirium Central

  https://www.deliriumcentral.org/

  Delirium can have serious complications, including long-term declines in functioning, loss of independence, tremendous healthcare costs, and death. […] However, many cases of delirium are preventable, and managing and decreasing the complications of delirium can be accomplished with awareness and recognition of the problem. […] Delirium Central contains an extensive list of resources for clinicians, researchers, family members, and patients who are interested in learning more about delirium prevention. […] Another great resource for clinicians is the AGS CoCare: Hospital Elder Life Program (HELP). HELP is an innovative model of hospital care designed to prevent delirium and functional decline in hospitalized older adults. […] To transform the clinical care of delirium and to address preventable contributors to cognitive decline, dementia, and Alzheimers disease, and to promote healthy brain aging through research, innovation, collaboration, clinical program development, and policy change.

• #27 Delirium in Older Persons: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0801/p150.html

  Assessment for and prevention of delirium should occur at admission to the hospital and throughout the stay. […] Prevention efforts targeting persons at risk may decrease delirium incidence, hospital costs, and associated poor outcomes. […] Studies have demonstrated that a multicomponent nonpharmacologic approach is highly effective and reduces the number and duration of episodes of delirium. […] One such intervention, known as the Hospital Elder Life Program, is available at http://www.hospitalelderlifeprogram.org. This intervention has been shown to reduce the number of patients with functional decline and placement in long-term care facilities. […] Inpatient consultation focusing on geriatric syndromes has also been shown to decrease delirium incidence. […] Nonpharmacologic prevention strategies consist of orientation and therapeutic activities, early and recurrent mobilization, minimizing the use of psychoactive medications, promoting normal sleep-wake cycles, providing easy access to adaptive equipment for sensory impairment (e.g., glasses, hearing aids), and preventing dehydration. […] All caretakers should be educated on preventive approaches and encouraged to implement them. […] The Hospital Elder Life Program has also developed the Family Confusion Assessment Method, a validated screening tool that can be used by trained family members to detect delirium.

• #28 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Be aware that people in hospital or long-term care may be at risk of delirium. This can have serious consequences (such as increased risk of dementia and/or death) and, for people in hospital, may increase their length of stay in hospital and their risk of new admission to long-term care. […] Ensure that people at risk of delirium are cared for by a team of healthcare professionals who are familiar to the person at risk. Avoid moving people within and between wards or rooms unless absolutely necessary. […] The tailored multicomponent intervention package should be delivered by a multidisciplinary team trained and competent in delirium prevention. […] Address cognitive impairment and/or disorientation by: providing appropriate lighting and clear signage; a clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods.

• #29 Delirium | MedlinePlus

  https://medlineplus.gov/delirium.html

  Treating the conditions that can cause delirium may reduce the risk of getting it. […] Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that hospital rooms are kept quiet, calm, and well-lit. […] It can also help to have family members around and to have the same staff members treat the person each day (if possible).

• #30 Delirium in elderly adults: diagnosis, prevention and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3065676/

  A recent controlled trial also found that home rehabilitation after acute hospitalization in elderly individuals was associated with a lower risk of delirium, and greater patient satisfaction, when compared with the inpatient hospital setting. […] Recent studies have examined the role of pharmacological strategies in delirium prophylaxis. […] Haloperidol has been shown to reduce the incidence of delirium in a small group of patients who underwent surgery. […] This reduction in incidence was not confirmed statistically in a larger study, but haloperidol did reduce the severity and duration of delirium and length of hospital stay in some patients without causing notable adverse effects. […] Owing to methodological limitations and small sample sizes, these results need to be confirmed before haloperidol can be recommended for routine prophylaxis.

• #31 Delirium – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/diagnosis-treatment/drc-20371391

  Coping and support […] If you’re a relative or caregiver of someone who is at risk of delirium, you can take steps to prevent an episode. If you take care of someone who is recovering from delirium, these steps can help improve the person’s health and prevent another episode. […] […] To help prevent medical problems: […] – Give the person the proper medicines on schedule […] – Provide plenty of fluids and a healthy diet […] – Encourage regular physical activity […] – Get prompt treatment for potential problems, such as infections

• #32 Confusion – symptoms, causes and prevention | healthdirect

  https://www.healthdirect.gov.au/confusion

  Confusion can be the sign of a serious medical condition. Call triple zero (000) and ask for advice if you (or someone you care for) experience a sudden onset of confusion or […] You can reduce the chance of becoming confused by managing your blood sugar levels, avoiding drug use, getting enough sleep and wearing glasses and/or hearing aids as needed. […] To reduce the chance of becoming confused: maintain a healthy diet, get enough sleep, wear glasses and/or hearing aids as prescribed, manage your blood sugar levels to prevent hypoglycaemia or hyperglycaemia if you have diabetes, avoid drinking too much alcohol, avoid drug use. […] If you are with a confused person who needs help, here are some tips: Stay with them. If they have diabetes, check their blood sugar levels if possible. If their sugar levels are high, encourage them to take their medicines. Seek medical advice if symptoms worsen. If their levels are too low, give them a sugary snack or drink and wait 10 minutes. If there’s no improvement, call triple zero (000) and ask for an ambulance.

• #33 Ask the Expert: Prevention and Treatment of Post-Operative Delirium | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/ask-expert-prevention-and-treatment-post-operative-delirium

  Delirium is a term meaning sudden confusion. It refers to a sudden change in mental function. Delirium can cause people to be either aggressive and agitated, or sleepy and inactive or sometimes a combination of both. […] Studies have shown delirium is preventable up to 40% of the time for older adults in the hospital. Some causes of delirium can be managed so they do not happen or get worse. […] There are some steps healthcare providers can take to help prevent post-operative delirium. The American Geriatrics Society Clinical Guideline for Post-Operative Delirium recommends the following. […] Prescribe prevention plans with multiple parts, such as: Having the patient walk multiple times daily, Orienting the patient to their location and the time multiple times daily, Allowing overnight sleep without disruptions or waking patient up, Making sure the older person gets enough fluid to avoid dehydration, Preventing infection, Avoiding use of internal bladder catheters and physical restraints, Making sure the older person has their glasses and/or hearing aids.

• #34 Ask the Expert: Prevention and Treatment of Post-Operative Delirium | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/ask-expert-prevention-and-treatment-post-operative-delirium

  Provide ideal pain control to older persons after surgery, with non-opioid pain medications (if possible). Keeping pain under control after surgery is linked to decreased delirium. […] Avoid medicines that can cause delirium. These include certain drugs used for anxiety, itching, insomnia, depression, Parkinson’s disease, irritable bowel syndrome, and overactive bladder. Talk to your healthcare provider if you have any concerns about the medicines you are taking. […] Delirium is a true medical emergency that requires immediate professional attention and treatment. […] The next step in treating a patient with delirium is providing a helpful environment similar to the prevention plan described above. The healthcare professional will also probably adjust or stop any medicines that the older person is taking, unless the medicine is necessary.

• #35 Preventing and Managing Delirium in Hospitalized Patients | St. Luke’s Health

  https://www.stlukeshealth.org/resources/preventing-and-managing-delirium-in-hospitalized-patients

  Delirium is an ongoing problem in hospitalized patients everywhere. […] St. Lukes Health has been and remains at the leading edge in delirium prevention and management. […] Delirium, a sudden confusion or acute brain failure, is widespread among older, hospitalized patients. […] Key factors influencing the change are increased staff, better awareness of the condition and investigation into effective strategies to improve patient outcomes. […] One study showed that use of a multidisciplinary delirium management team, composed of a physician, clinical pharmacist and registered nurse-delirium coordinator, reduced delirium and ICU length of stay. […] Another study demonstrated that use of a bundle of interventions reduced the odds of delirium in ICU patients by 78 percent. […] A third study found the use of exercise physiologists in the ICU resulted in earlier mobilization of patients, crucial because mobilization has been shown to reduce delirium.

• #36 Preventing and Managing Delirium in Hospitalized Patients | St. Luke’s Health

  https://www.stlukeshealth.org/resources/preventing-and-managing-delirium-in-hospitalized-patients

  SLH has since developed these research findings into a protocol and implemented them with a multidisciplinary team, as prevention and management of delirium is truly a multidisciplinary effort. […] We also utilize a delirium prevention bundle that includes: Adequate pain management, Daily cessation of sedation, Early mobilization using exercise physiologists, Sensory stimulation during the day, Sleep promotion. […] We have found that the more time families can spend with the patient, the more the patient is likely to be reassured and reoriented, which reduces delirium. […] All too often, delirium can stem from medications. […] Both physicians and the clinical pharmacist review every patient’s medications every day to minimize the use of drugs that can worsen delirium, such as steroids, opioids and the benzodiazepine class of sedatives.

• #37 Diagnosis, prevention and management of delirium: spot it, stop it, treat it | BJPsych Advances | Cambridge Core

  https://www.cambridge.org/core/journals/bjpsych-advances/article/diagnosis-prevention-and-management-of-delirium-spot-it-stop-it-treat-it/3F58BA5AE303B426E9FE72817D847F29

  Social interactions are also integral to reducing delirium risk and can be facilitated by family and visitors as well as the hospital staff. […] In terms of preventing delirium in critical care patients, use of anaesthetics such as dexmedetomidine (an alpha-2 agonist) as adjuncts to GABAergic agents (e.g. propofol, midazolam) has been supported by evidence. […] Melatonin may reduce the incidence of post-operative delirium by allowing for improved sleep.

• #38 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics/print

  DELIRIUM TREATMENT […] There is no specific treatment for delirium. Instead, treatment focuses on several basic principles: […] Avoid factors known to cause or aggravate delirium, such as certain medications […] Identify and treat the underlying illness […] Provide supportive and restorative care […] Control dangerous and disruptive behaviors to avoid harm to the patient or others […] In people with a first episode of delirium, the initial treatment is often provided in a hospital setting. This allows the health care provider to monitor the patient, begin treatment of the underlying problem, and develop a long-term care plan with the patient and/or family. […] Supportive care — The goal of supportive care is to maintain the patient’s health, prevent additional complications, and avoid those factors that can aggravate delirium. This includes:

• #39 Abrupt change in mental status | HIGN

  https://hign.org/consultgeri/resources/symptoms/abrupt-change-mental-status

  The most important action for the management of delirium is identifying and treating the underlying cause of symptoms, such as dehydration, hypoxemia, and hypoglycemia. […] Non-pharmacological approaches to managing anxiety and promoting sleep and relaxation, such as massage, music, and warm beverages, are encouraged. […] It is important that patients have access to all sensory assistive devices, such as glasses, hearing aids, and dentures, to improve sensation and perception and reduce risk of disorientation and agitation. […] In all health care systems, providers and nurses would benefit from staff training by geriatric psychiatrists and specialists to recognize and differentiate symptoms of delirium from dementia. This knowledge is essential to prevent and manage abrupt change in mental status in older adults. […] Efforts to educate the public about the prevalence of delirium and its risk factors for older adults will also help to address the under-recognition of delirium and its mismanagement in the clinical setting.

• #40 Confusion/Delirium – Virginia Cancer Institute

  https://www.vacancer.com/diagnosis-and-treatment/side-effects-of-cancer/confusiondelirium/

  Confusion or delirium is a state of brain dysfunction and may be a side effect of cancer or cancer treatment. The first approach to treating confusion is to treat the cause. […] At this time, there are no proven treatments for confusion associated with chemotherapy or other treatments. Perhaps the best approach for relieving confusion is to treat the cause. For example: Stop or reduce the medications that causes delirium, Give IV (intravenous) fluids to correct dehydration, Treat hypercalcemia (too much calcium in the blood) and other electrolyte imbalances, Treat a fever/infection with antibiotics. […] If steps to reverse confusion through treating the cause are unsuccessful, antipsychotic or sedative drugs may be utilized. If the patient is near death, sedatives can be very helpful for calming.

• #41 Evaluation and Management of Delirium in Hospitalized Older Patients | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1201/p1265.html

  Delirium is common in hospitalized older patients and may be a symptom of a medical emergency, such as hypoxia or hypoglycemia. […] Interventions that have been shown to reduce the incidence of delirium in at-risk hospitalized patients include repeated reorientation of the patient to person and place, promotion of good sleep hygiene, early mobilization, correction of dehydration, and the minimization of unnecessary noise and stimuli. […] Addressing six risk factors (i.e., cognitive impairment, sleep deprivation, dehydration, immobility, vision impairment, and hearing impairment) in at-risk hospitalized patients can reduce the incidence of delirium by 33 percent. […] Hospital staff educational programs have been shown to effectively reduce delirium duration and related mortality. […] The optimal treatment of delirium involves primary prevention, which includes the reduction of modifiable risk factors.

• #42 Abrupt change in mental status | HIGN

  https://hign.org/consultgeri/resources/symptoms/abrupt-change-mental-status

  The most important action for the management of delirium is identifying and treating the underlying cause of symptoms, such as dehydration, hypoxemia, and hypoglycemia. […] Non-pharmacological approaches to managing anxiety and promoting sleep and relaxation, such as massage, music, and warm beverages, are encouraged. […] It is important that patients have access to all sensory assistive devices, such as glasses, hearing aids, and dentures, to improve sensation and perception and reduce risk of disorientation and agitation. […] In all health care systems, providers and nurses would benefit from staff training by geriatric psychiatrists and specialists to recognize and differentiate symptoms of delirium from dementia. This knowledge is essential to prevent and manage abrupt change in mental status in older adults. […] Efforts to educate the public about the prevalence of delirium and its risk factors for older adults will also help to address the under-recognition of delirium and its mismanagement in the clinical setting.

• #43 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics/print

  DELIRIUM TREATMENT […] There is no specific treatment for delirium. Instead, treatment focuses on several basic principles: […] Avoid factors known to cause or aggravate delirium, such as certain medications […] Identify and treat the underlying illness […] Provide supportive and restorative care […] Control dangerous and disruptive behaviors to avoid harm to the patient or others […] In people with a first episode of delirium, the initial treatment is often provided in a hospital setting. This allows the health care provider to monitor the patient, begin treatment of the underlying problem, and develop a long-term care plan with the patient and/or family. […] Supportive care — The goal of supportive care is to maintain the patient’s health, prevent additional complications, and avoid those factors that can aggravate delirium. This includes:

• #44 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics/print

  Making sure the person gets enough to eat and drink (or providing nutrition through an IV, if needed) […] Treating pain and avoiding discomfort, including avoiding constipation […] Minimizing the use of restraints and bladder catheters, which can be uncomfortable, particularly to confused patients […] Encouraging movement (getting out of bed in order to walk) with necessary assistance to avoid falls […] Having someone help during meals and having the person sit upright to minimize the risk of inhaling food, drinks, and/or saliva, which can lead to pneumonia […] Maintaining a regular night-day/sleep-wake cycle when possible and avoiding sleep deprivation […] Maintaining a reassuring and familiar environment with one or two visiting family members or familiar objects/pictures from home

• #45 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics/print

  Avoiding overstimulation (eg, multiple visitors, loud noise), which can worsen delirium, but also avoiding understimulation (darkened room, complete silence) […] Making hearing aids and eyeglasses available at the hospital if the patient uses these at home […] Managing behaviors — Some people with delirium have disruptive behaviors, potentially causing them to harm themselves or others. The person may say or do things that are obscene or offensive, but such behaviors do not reflect the person’s true beliefs. The person may also be at risk for falling, wandering off, or inadvertently removing intravenous lines. […] Sitter — Allowing a family member or other caregiver to stay with the patient at the bedside may help to manage the patient’s behavior. This person can provide reassurance, answer questions, reorient the patient, and notify staff if the person needs assistance. In some cases, the hospital is able to provide a sitter if a family member is unavailable. However, a familiar and trusted family member or friend can provide additional reassurance to the patient.

• #46 Ask the Expert: Prevention and Treatment of Post-Operative Delirium | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/ask-expert-prevention-and-treatment-post-operative-delirium

  General supportive care (for example, orienting the patient or providing a healthy sleeping environment) is very important for an older adult with delirium in the hospital. Special care should be taken to also prevent complications such as dehydration, malnutrition, joint stiffness, pressure ulcers, constipation, or wetting the bed. […] The American Geriatrics Society Clinical Guideline for Post-Operative Delirium recommends the following to treat postoperative delirium: Healthcare professionals should consider working with an interdisciplinary team to use multiple approaches to treatment. These can include approaches such as improving sleep, helping to reorient the older person to their surroundings, or engaging in therapeutic activities. […] The healthcare professional should identify and manage underlying causes of delirium. To help diagnose the underlying causes, the healthcare provider should: Perform a medical evaluation, Adjust medicines as necessary, Make changes to the older adult’s surroundings, if necessary, Order appropriate tests.

• #47 Evaluation and Management of Delirium in Hospitalized Older Patients | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1201/p1265.html

  Delirium is common in hospitalized older patients and may be a symptom of a medical emergency, such as hypoxia or hypoglycemia. […] Interventions that have been shown to reduce the incidence of delirium in at-risk hospitalized patients include repeated reorientation of the patient to person and place, promotion of good sleep hygiene, early mobilization, correction of dehydration, and the minimization of unnecessary noise and stimuli. […] Addressing six risk factors (i.e., cognitive impairment, sleep deprivation, dehydration, immobility, vision impairment, and hearing impairment) in at-risk hospitalized patients can reduce the incidence of delirium by 33 percent. […] Hospital staff educational programs have been shown to effectively reduce delirium duration and related mortality. […] The optimal treatment of delirium involves primary prevention, which includes the reduction of modifiable risk factors.

• #48 Delirium in Older Persons: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0801/p150.html

  Assessment for and prevention of delirium should occur at admission to the hospital and throughout the stay. […] Prevention efforts targeting persons at risk may decrease delirium incidence, hospital costs, and associated poor outcomes. […] Studies have demonstrated that a multicomponent nonpharmacologic approach is highly effective and reduces the number and duration of episodes of delirium. […] One such intervention, known as the Hospital Elder Life Program, is available at http://www.hospitalelderlifeprogram.org. This intervention has been shown to reduce the number of patients with functional decline and placement in long-term care facilities. […] Inpatient consultation focusing on geriatric syndromes has also been shown to decrease delirium incidence. […] Nonpharmacologic prevention strategies consist of orientation and therapeutic activities, early and recurrent mobilization, minimizing the use of psychoactive medications, promoting normal sleep-wake cycles, providing easy access to adaptive equipment for sensory impairment (e.g., glasses, hearing aids), and preventing dehydration. […] All caretakers should be educated on preventive approaches and encouraged to implement them. […] The Hospital Elder Life Program has also developed the Family Confusion Assessment Method, a validated screening tool that can be used by trained family members to detect delirium.

• #49 Nutrition and Delirium | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-63892-4_19

  Multicomponent multidisciplinary prevention programs can reduce delirium by 30-50% in hospital settings. […] These programs focus on optimising nutrition and hydration, mobility and engagement in meaningful activities, as well as managing pain, managing sleep disturbance and reducing or eliminating inappropriate medications. […] Maintaining food and fluid intake is a central strategy within delirium prevention programs. […] Nurses should anticipate the assistance that patients with, or at risk of, delirium may require and factor these into their daily workflow planning. […] Decision-making about enteral feeding for a patient with delirium is complex and must be individualised in line with patient goals and the prognosis of the underlying conditions. […] Engaging and supporting caregivers and family in discharge planning and ongoing nutritional care, meeting unmet needs by referring to community health and support services for practical assistance with shopping and meal preparation, providing oral nutrition supplements (if well accepted) and ensuring nutritional monitoring and follow-up in the community are key strategies to optimise recovery after hospitalisation.

• #50 Home – Delirium Central

  https://www.deliriumcentral.org/

  Delirium can have serious complications, including long-term declines in functioning, loss of independence, tremendous healthcare costs, and death. […] However, many cases of delirium are preventable, and managing and decreasing the complications of delirium can be accomplished with awareness and recognition of the problem. […] Delirium Central contains an extensive list of resources for clinicians, researchers, family members, and patients who are interested in learning more about delirium prevention. […] Another great resource for clinicians is the AGS CoCare: Hospital Elder Life Program (HELP). HELP is an innovative model of hospital care designed to prevent delirium and functional decline in hospitalized older adults. […] To transform the clinical care of delirium and to address preventable contributors to cognitive decline, dementia, and Alzheimers disease, and to promote healthy brain aging through research, innovation, collaboration, clinical program development, and policy change.

• #51 Delirium: When You Should Be Concerned About Confusion | University of Utah Health

  https://healthcare.utah.edu/healthfeed/2017/03/delirium-when-you-should-be-concerned-about-confusion

  A sudden onset of confusion caused by a medical condition is known as delirium, and it can have serious consequences. […] One of the big drivers of trying to prevent delirium is that its associated with so many bad outcomes, according to Sanders. […] A patient who has experienced delirium is also at a higher risk of readmission to the hospital and of developing dementia. […] However, theres no approved medical treatment for delirium, so Beattie insists that prevention is key. […] Fortunately, delirium is easier to prevent than it is to detect. Prevention focuses on keeping the patients baseline at its normal level. […] Awareness and prevention of delirium will make a significant impact on your loved ones continuing health.

• #52 Preventing and treating delirium in clinical settings for older adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10493062/

  Prevention of delirium is most often accomplished by identifying and addressing the many vulnerabilities that increase risk for delirium. […] Prevention strategies can be divided into both nonpharmacological and pharmacological interventions, and several multi-component nonpharmacological approaches to delirium management focus on prevention. […] The most well studied are the Hospital Elder Life Program (HELP) and the ABCDEF bundle. […] A 2015 meta-analysis found that 11 studies with 4267 patients demonstrated that multi-component nonpharmacological delirium interventions reduced delirium incidence (odds ratio: 0.47; 95% CI: 0.380.58) with a number needed to treat of 14.3 (95% CI: 11.120.0). […] In contrast to the success of nonpharmacological approaches, pharmacological interventions have proven less helpful in preventing delirium. […] Despite the significance of delirium, there are few proven strategies for treatment once it develops, and thus interventions aimed at prevention should be prioritized.

• #53 Delirium – Wikipedia

  https://en.wikipedia.org/wiki/Delirium

  Treating delirium that is already established is challenging and for this reason, preventing delirium before it begins is ideal. Prevention approaches include screening to identify people who are at risk, and medication-based and non-medication based (non-pharmacological) treatments. […] An estimated 30-40% of all cases of delirium could be prevented in cognitively at-risk populations, and high rates of delirium reflect negatively on the quality of care. […] Episodes of delirium can be prevented by identifying hospitalized people at risk of the condition. This includes individuals over age 65, with a cognitive impairment, undergoing major surgery, or with severe illness. […] Routine delirium screening is recommended in such populations. It is thought that a personalized approach to prevention that includes different approaches together can decrease rates of delirium by 27% among the elderly.

• #54 Delirium | Healthify

  https://healthify.nz/health-a-z/d/delirium

  The PINCHES ME Kindly approach can be useful to help avoid delirium in older people and sick people: […] Pain manage with the help of your healthcare provider. […] Infection avoid by going to the toilet regularly, checking your skin for redness or irritated areas, telling your healthcare provider about any fevers (high temperatures). […] Nutrition eat plenty of good food. […] Constipation avoid by going to the toilet regularly, and talking to your healthcare provider if you’re not opening your bowels (passing poo) as usual. […] Hydration drink plenty of water. […] Exercise do appropriate amounts of exercise but don’t overdo it. […] Sleep regular sleep is important. Talk to your healthcare provider if you’re not sleeping well. […] Medication only as necessary. Talk to your healthcare provider occasionally to see if there are any medicines you no longer need. […] Environment calm and quiet is better that noisy or busy. Keep glasses and hearing aids nearby and use them when needed.

• #55 New or worsened confusion | Queensland Health

  https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/clinical-pathways/residential-aged-care-clinical-pathways/all-pathways/new-or-worsened-confusion

  Bundle of delirium supportive care and risk reduction strategies: Assess, prevent and manage pain and constipation and regularly reassess; Best practice personal care: maintain hygiene and mouth cares, support toileting, maintain skin integrity (institute pressure injury prevention and daily skin moisturising for intact skin), sleep hygiene; Correct hypoxia and electrolyte abnormalities; Communicate clearly and orient resident (verbal orientation, clock visible); Consistency of staff and environment; Drugs: cease anticholinergic drugs and reduce medication burden where this is clinically appropriate; Deficits: address sensory deficits – ensure resident has their glasses / hearing aids available; Diet and dehydration: where clinically appropriate, support oral intake, ensure residents dentures fitted, maintain hydration, monitor food and fluid intake; Encourage and support mobility and assist self-care; Environment: diurnal lighting (access to natural lighting or ensure lighting follows day-night lighting), remove clutter that poses falls risk, low stimulus environment; Family engagement and empowerment to provide supportive care, reassurance and comfort; Falls prevention plan.

• #56 Delirium – Definition, Symptoms, and Causes

  https://www.mentalhealth.com/library/delirium

  Given the right conditions and by identifying and removing the cause, delirium is reversible. Preventing delirium is possible by identifying risk factors in individuals with predisposing factors such as age or comorbidities and being aware of adding precipitating factors like certain psychoactive medications. […] Minimizing the risk factors for delirium is vital in preventing it, not only for the individual but for carers, family members and healthcare professionals. […] Critical factors that can increase the risk of delirium are: 65 years of age or older, a clinical condition that is deteriorating, medical illness, cognitive impairment (past or present), use of psychoactive drugs.

• #57 Delirium vs Dementia: 10 Things to Know for Aging Health

  https://betterhealthwhileaging.net/what-is-delirium-10-things-to-know/

  Delirium is preventable, although not all cases can be prevented. Experts estimate that delirium is preventable in about 40% of cases. Preventive strategies are meant to reduce stress and strain on an older person, and also try to minimize delirium triggers, such as uncontrolled pain or risky medications. […] In the hospital setting, programs such as the Hospital Elder Life Program (HELP) for Prevention of Delirium have been shown to work. […] To prevent hospital delirium, carefully weigh the risks and benefits before proceeding with elective surgery. If your older loved one must be hospitalized, choose a facility using the HELP program or with an Acute Care for Elders unit if possible. […] By educating yourself and helping your older loved ones be proactive about prevention, you can reduce the chance of harm from this condition.

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