- Assess bowel and bladder
- Early mobilization + frequent mobilization
- Continuous observation – Sitter. Strictly limit the use of restraints.
- Nutrition/hydration (feeding assistance)
- Pain management – Be vigilant for and treat pain
- Sleep enhancement – Promote normal sleep-wake cycle
- Correct sensory deficits – Hearing and vision adaptations
- Environmental modification: Frequent orientation, familiar objects, family and caregiver presence (social support); Improve sensory perception (e.g. with hearing aids, glasses); Remove IV lines, Catheters, etc that are not needed.
- Daytime stimulation: Cognitive activities, ambulation (walking/ daily exercise)
- Geriatric interdisciplinary care
The National Institute for Health and Clinical Excellence (NICE) has issued recommendations for prevention, diagnosis, and management of delirium, including the following:
- Identify patients at risk of delirium
- Establish a multidisciplinary healthcare team to prevent and manage delirium
- Avoid moving the patient between different rooms and wards.
- Ensure appropriate lighting, signage, and cognitive stimulation; encourage visits from family and friends.
- Maintain hydration and avoid constipation.
- Prevent and treat hypoxia and infections.
- Encourage mobility with appropriate assistance and supervision.
- Assess and manage pain and sensory impairment.
- Review medications to determine whether any may increase the risk of delirium.
- Promote and maintain nutrition and sleep hygiene.
- Additional studies have shown that consultation from surgery to specialized medical teams that focus on the older patient can reduce the relative odds of dying 1 year after hospitalization to 0.69 (95% confidence interval: 0.57–0.83).