Prevention

• Reduce exposure to modifiable risk factors.

  • Avoid drugs that can worsen delirium (e.g., benzodiazepines, anticholinergics, opioids).

  • Avoid restraints if possible.

  • Ensure that the patient is comfortable and that symptoms are well controlled (see “Supportive care” in “Management” section).

• Reorient the patient regularly.

  • Keep a clock and/or calendar near the patient to help with orientation.

  • Provide visual and hearing aids for patients with impairments.

  • Keep curtains open and lights on during daytime hours.

• At night, reduce the amount of noise, procedures, and medication administration.

  • Disorientation may be worse if the patient is awoken at night.

  • Uninterrupted sleep is important for both prevention and management of delirium.

  • See also “Inpatient management of insomnia.”

• Arrange for regular visits from family and friends.

• Regularly assess at-risk patients using the CAM tool to detect delirium early.

• Some medications (e.g., dexmedetomidine, melatonin) have been used to prevent delirium in the critical care/postoperative settings, but benefits are still uncertain. [16]

Uninterrupted sleep is particularly important in patients with delirium, who may experience a worsening of neuropsychiatric symptoms in the evening and at night known as sundowning.

Cholinesterase inhibitors have not been shown to be effective in the prevention or treatment of delirium. However, patients requiring long-term treatment cholinesterase inhibitors can continue to use them.