Evidence-Based Practice Guideline: Delirium

Abstract

Delirium is a common cause of morbidity and mortality in hospitalized older adults often superimposed on dementia. Older patients with delirium are more likely than other populations to develop hospital-acquired infections, pressure ulcers, and immobility and nutritional issues, as well as to have increased health care costs, longer hospital stays, and long-term care following discharge. Interventions that prevent or mitigate the effects of delirium while promoting recovery are essential for caring for hospitalized older patients. This article is a summary of an evidence-based guideline that includes a framework for addressing delirium that focuses on predisposing and precipitating factors for delirium. In addition, the guideline includes evidence-based assessment and intervention principles, along with a review of reliable and valid assessment instruments. The guideline also identifies measurable outcomes for managing delirium and a quality improvement approach for improving outcomes. [Journal of Gerontological Nursing, 44(2), 14-24.].

Risk Factors for Nursing Home Delirium: A Systematic Review

“…Delirium has three motor subtypes: hyperactive, hypoactive, and mixed-motor subtype [2]. In a prior study conducted in another setting (intensive care unit, ward) [20], no studies on nursing homes were conducted that classified the occurrence of delirium. In future studies, it is necessary to investigate the classification of delirium.…”

“…Predisposing factors are affecting patients' vulnerability for developing delirium during hospitalization and these are often unmodifiable. These are age-related changes or patient characteristics [20]. In this review, age was an important factor in almost all papers as a possible risk factor [4][5][6]9,[15][16][17].…”

“…Precipitating factors are potentially modifiable and contribute to the development of delirium [20]. Use of physical restraint (chair restraints, bed rails restraints, trunk restraints) is a major precipitating factor related to delirium among nursing home residents [6,17].…”

“…Nine factors were classified as predisposing risk factors that are resident characteristics and are often unmodifiable. Six factors were classified as precipitating factors, preceding the development of delirium, and are potentially modifiable [20].…”

Top Ten Tips Palliative Care Clinicians Should Know About Cognitive Impairment and Institutional Care

“…27 Therefore, evidence-based delirium guidelines recommend that delirium screening (which is more common in acute care settings) continues in postacute care settings. 28 Multiple assessment tools, both observational instruments and cognitive tests, exist for detecting delirium. 28 The selection of one or more instruments (RADAR tool has been studied 9 ) to utilize as part of a delirium screening program at a nursing facility will need to be highly tailored depending on the goal of the screening, the frequency with which it will be performed, and the staff available to perform the screening.…”