Delirium Guidelines

Delirium and dementia

Delirium is:

  • A disturbance of brain function that develops over a short period of time and fluctuates during the course of the day
  • A condition with a PHYSICAL cause
  • The most common cause of a sudden change in behaviour in older people
  • Often managed inappropriately
  • A medical emergency.

Risk factors for delirium include:

  • Age > 70 years
  • Pre existing cognitive impairment (especially dementia)
  • Visual impairment
  • Depression
  • Indwelling catheter
  • Physical restraint
  • Addition of three or more medications

People with dementia often have more than one of the above risk factors and any sudden change in their behaviour should be treated as a delirium until proven otherwise.

Many of the signs and symptoms of delirium are mistaken for a ‘worsening’ of dementia in older people. Delirium on top of a pre-existing dementia can certainly exacerbate the symptoms of dementia, however, once the delirium is resolved the person with dementia resumes their level of pre-delirium function. Some of the signs and symptoms of delirium include:

  • Confused and forgetful
  • Unable to pay attention
  • Disturbance of sleep-wake cycle
  • Very agitated, or quiet and withdrawn, sleepy
  • Disorientated to time and place
  • Fluctuating and extreme emotions
  • Hallucinations

Management of delirium:

  • Environmental strategies – quiet, orientation cues, personal and familiar objects
  • Bed/room close to nurse’s station
  • Involve family
  • Make sure hearing and vision aids are used
  • Ensure adequate hydration and nutrition
  • Review medications
  • Check for infection

The Clinical Practice Guidelines for the Management of Delirium in Older People provides evidence based resources and guidelines for the detection, prevention and management of delirium in older people.

Barwon Health delirium guidelines