Risk factors | |
---|---|
Age 65 years or older | |
Cognitive impairment (past or present) and/or dementia | |
Current hip fracture | |
Severe illness (a clinical condition that is deteriorating or is at risk of deterioration) | |
Interventions to prevent delirium | |
Clinical factor | Preventative intervention |
Cognitive impairment or disorientation | • Provide 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. |
• Reorientate the person by explaining where they are, who they are, and what your role is. | |
• Introduce cognitively stimulating activities (for example, reminiscence). | |
• Facilitate regular visits from family and friends. | |
Dehydration or constipation | • Encourage the person to drink. Consider offering subcutaneous or intravenous fluids if necessary. |
• Seek advice if necessary when managing fluid balance in people with comorbidities (for example, heart failure or chronic kidney disease). | |
Hypoxia | • Assess for hypoxia and optimise oxygen saturation if necessary. |
Immobility or limited mobility | • Encourage the person to: |
â—‹ mobilise soon after surgery | |
○ walk (provide walking aids if needed – these should be accessible at all times). | |
• Encourage all people, including those unable to walk, to carry out active range-of-motion exercises. | |
Infection | • Look for and treat infection. |
• Avoid unnecessary catheterisation. | |
• Implement infection control procedures in line with ‘Infection control’ (NICE clinical guidance 2). | |
Multiple medications | • Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. |
Pain | • Assess for pain. Look for non-verbal signs of pain, particularly in people with communication difficulties. |
• Start and review appropriate pain management in any person in whom pain is identified or suspected. | |
Poor nutrition | • Follow the advice given on nutrition in ‘Nutrition support in adults’ (NICE clinical guidance 32). |
• If the person has dentures, ensure they fit properly. | |
Sensory impairment | • Resolve any reversible cause of the impairment (such as impacted ear wax). |
• Ensure working hearing and visual aids are available to and used by people who need them. | |
Sleep disturbance | • Avoid nursing or medical procedures during sleeping hours, if possible. |
• Schedule medication rounds to avoid disturbing sleep. | |
• Reduce noise to a minimum during sleep periods. |