Risk factors for delirium outlined by NICE:

• ≥65 y/o
• Cognitive impairment (past or present)
• Dementia
• Current hip fracture
• Severe illness

To distinguish between delirium and dementia, NICE recommends using the:

• Confusion assessment method (CAM)
• Observational Scale of Level of Arousal (OSLA)

 

Prevention of various common causes of delirium as outlined by NICE:
 

Risk Factor / Cause	Specific Preventive Actions
Cognitive impairment / Disorientation	Provide appropriate lighting and clear signage Ensure a clock and calendar are easily visible Talk to re-orientate (where / who / role) Introduce cognitively stimulating activities Facilitate visits from family/friends
Dehydration / Constipation	Encourage adequate fluid intake Offer subcutaneous/intravenous fluids if necessary Seek specialist advice for fluid management in comorbidities (heart failure, CKD, etc.)
Hypoxia	Assess for hypoxia and optimise oxygen saturation as needed Be aware of pulse oximeter limitations (esp. borderline values and skin colour differences)
Infection	Actively look for/treat infection Avoid unnecessary catheterisation Follow infection control procedures as per guidelines
Immobility / Reduced Mobility	Encourage early mobilisation after surgery Provide walking aids and keep them accessible Encourage active range-of-motion exercises, even for non-ambulatory individuals
Pain	Assess for pain, including non-verbal signs Initiate and review appropriate pain management
Medication burden / Polypharmacy	Review all medications being taken (type and number) Follow medicine optimisation protocols
Poor nutrition	Follow nutrition support guidelines Ensure dentures fit properly if applicable
Sensory impairment	Address reversible causes (e.g., earwax for hearing) Ensure hearing/visual aids are available, in good condition, and used
Sleep disruption	Avoid procedures and medication rounds during sleep if possible Minimise noise during sleep periods

 

Treat any underlying causes

• Exclude reversible causes of delirium (see above)
• Medication review and optimise where appropriate

Management of distressed patients:

• 1st line: verbal and non-verbal de-escalation techniques

 

• 2nd line: short-term haloperidol (usually ≤1 week)
  • Avoid in those with Parkinson's disease or dementia with Lewy bodies
  • Lorazepam is preferred if necessary, or if an antipsychotic is necessary, quetiapine is preferred

NICE guideline Delirium: prevention, diagnosis and management in hospital and long-term care

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