1. Assess bowel and bladder
  2. Early mobilization + frequent mobilization
  3. Continuous observation – Sitter. Strictly limit the use of restraints.
  4. Nutrition/hydration (feeding assistance)
  5. Pain management –  Be vigilant for and treat pain
  6. Sleep enhancement  – Promote normal sleep-wake cycle
  7. Correct sensory deficits – Hearing and vision adaptations
  8. 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.
  9. Daytime stimulation: Cognitive activities, ambulation (walking/ daily exercise)
  10. 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).
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