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PRINCIPLE 2: Delirium risk identification and prevention strategies

Older people will be assessed for delirium risk. Interventions will be put in place for prevention of identified risks. Identified risks will be communicated to the older person, their carer, family and staff involved in their care.

Preventive measures

Multifactorial prevention strategies involving specialist geriatric medical and nursing intervention have the potential to reduce the incidence of delirium, the duration of delirium and the severity of delirium (1).

Strategies to prevent delirium address modifiable risk factors for delirium, by identifying and reducing precipitating risk factors and their severity (1).  This involves:

  1. Identifying and managing delirium risk factors, such as use of physical restraint, adding three or more medications, multiple bed moves, dehydration.
  2. Interventions to promote:
  • healthy rest and sleep
  • mental stimulation
  • orientation
  • healthy vision
  • healthy hearing
  • healthy eating
  • physical activity
  • bowel management
  • environmental factors.

Strategies to prevent delirium are the same as strategies to manage existing dementia or delirium – see Management strategies.

These non-pharmacological and psychosocial interventions focus on delivering quality care based on respect for the values and background of the older person. They include getting to know the older person and supporting them to maintain their independence and function.

  • Risk prevention strategies should be discussed with the patient, carers and family.
  • High risk patients should be flagged, particularly during handover or transfer of care

References

  1. Clinical Epidemiology and Health Service Evaluation Unit, Melbourne Health in collaboration with the Delirium Clinical Guidelines Expert Working Group. Clinical Practice Guidelines for the Management of Delirium in Older People, 2006.
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