Aging & Health A to Z

Delirium

Care & Treatment

Prevention

The best way to treat delirium is first to prevent it.  Research has shown that paying attention to six particular factors is most helpful in preventing delirium: 

1. Help orient cognitively impaired patients in time and place (using clocks, calendars, windows, blackboards with doctor’s and nurse’s names)

2. Get patients up and about as soon as possible
3. Minimize the use of psychoactive (mood) drugs by using non-drug therapies whenever feasible
4. Implement a healthy sleep-wake cycle, using windows, bright morning light, reduction in night noises, etc
5. Improve sensory input and communication using appropriate aids, especially good eyeglasses and hearing aids, if needed
6. Give plenty of fluids, and make sure patients don’t get dehydrated. 

Treatment Starts Here

Delirium is a true medical emergency. For this reason, you must get immediate professional attention and treatment. The main goal of treatment is to identify and correct the underlying causes of the syndrome using tests described in the Diagnosis and Tests section.  Your healthcare professional will:

• identify the condition and the specific cause as quickly as possible
• manage agitation or disruptive behavior
• provide general supportive care. 

He or she will probably stop or reduce the dosage of all drugs, unless they are absolutely necessary. 

Supportive Care
Care for older people with delirium involves special hospital care with careful attention to medical, environmental, and social situations. Delirious patients are particularly vulnerable to medical complications such as dehydration or malnutrition, pressure ulcers, joint stiffness, constipation or wetting the bed because they aren’t able to move around much or because of reduced consciousness. These complications often result in poor outcomes.

Non-drug Management and Therapies for Delirium

Once an older patient develops delirium, you must manage the environment so that he or she feels oriented. Avoid moving the patient from one room or space to another unnecessarily, and try to keep staff changes to a minimum if possible. Encourage regular schedules for meals, tests, exercise, and monitoring. Family members, close friends, or even paid assistants should try to stay with the person in order to reduce the fear and anxiety often seen in delirium.  

Treat sleep problems, if possible, without drugs. Try warm milk or herbal tea, music, and massage in the evening, and keep nighttime noise to a minimum. Dim lights left on at night can help decrease delusions or hallucinations.

Encourage the patient to move and take walks three times every day, to practice range of motion exercises, and minimize the use of equipment that would keep him or her immobilized.

If an infection, pain, or other medical condition has been identified as a precipitating factor, ensure that it has been treated adequately.

Physical restraints are only used as a last resort to keep the patient safe and prevent him or her from pulling out tubes or catheters. There’s no evidence that they reduce falls or other accidents. Worse, they keep the person immobilized and this increases the risk of developing pneumonia or pressure ulcers. Accidental strangling is even a possibility. Also, restraints and very strong medications are considered a form of involuntary treatment and may violate the rights of an agitated person.

Professionals in social work and nursing are often quite skilled at helping people with delirium. Remember that a person suffering from delirium in the hospital may improve considerably once they return home to a familiar, stable environment. This should be kept in mind so that you don’t make the decision to place someone in a nursing home prematurely.

Delirium may take weeks or even months to truly resolve. Therefore, you should opt for supervised settings, and make sure there is close monitoring after the patient returns home, to ensure safety for everyone involved.

Drug Treatment/Medications

Drug treatment is often not necessary, or desirable. But if the patient is very agitated or aggressive and is behaving in a way that could hurt someone, medications might be the most effective approach. Most often, antipsychotic drugs such as haloperidol are used, but very cautiously. Quetiapine is the preferred drug for patients with Parkinson’s disease and certain types of dementia. Sedatives such as benzodiazepine, lorazepam, may help in certain cases, including alcohol withdrawal.  However, this type of drug can actually trigger delirium, so it is used briefly and only if absolutely necessary.  Sedatives are never used in people who are already drowsy.

Updated: March 2012
Posted: March 2012