The best way to deal with delirium is to prevent it.

Paying attention to the following things can help prevent delirium in hospitalized older adults:  

• Pay close attention to mental status. Ensure that people who will have surgery have their mental status checked before the procedure.
• Help people with cognitive (memory and thinking) problems understand time and place and who is treating them. Written signs can help.
• Get people up and about as soon as possible.
• Minimize the use of risky medications by using non-drug therapies whenever possible.
• Promote a healthy sleep-wake cycle. Use windows, bright morning light, and fewer night noises. Melatonin might help in those who can take it.
• Improve communication using aids, like eyeglasses, hearing aids, and dentures if needed.
• Make sure people are hydrated (have enough fluids). 

Treatment

Delirium is a medical emergency which requires quick treatment. The main goal of treatment is to identify and correct the cause of delirium. The healthcare provider will:

• Review all medications to see if they are helping to cause the delirium. 
• Consider possible causes for changes in behavior. For example:
  • A need to go to the bathroom
  • Pain
  • Emotions such as fear or boredom

Supportive Care

Care for older adults with delirium involves special attention to medical, environmental, and social situations. These things can happen because people aren’t able to move around much or have poor mental status.

People with delirium can have:

• Falls
• Not enough healthy food and fluids
• Pressure sores
• Stiff joints, constipation
• Problems with urinating 

Non-Pharmacologic Management and Therapies

To reduce the risk of delirium or treat its symptoms:

• Avoid changing the person’s environment or the healthcare workers they see, if possible.
• Keep regular schedules for meals, tests, exercise, and monitoring. 
• Have familiar people stay with the person to decrease fear and anxiety.
• Try to treat sleep problems without medications. 
• Encourage the person to move about three times a day.
• Treat any medical conditions.
• Do not use physical or drug-related restraints in most cases because they can harm or kill the person with delirium. Restraints are a violation of a person’s rights. 
  • An exception for restraints may be necessary for people in Intensive Care Units (ICUs) to prevent them from removing tubes and medical devices or to treat severe hallucinations or delusions.

Delirium may take weeks or even months to go away. So, when an older adult with delirium returns home, they need monitoring and supervision to make sure everyone is safe.

 Pharmacologic Treatment/Medications

Medications are generally not effective in delirium and can cause severe side effects, including death. Rarely, medications such as anti-psychotics or sedatives may be necessary in the case of severe symptoms of delirium. 

For older adults experiencing delirium, the basis of treatment is creating a safe, familiar, and supportive environment. 

Last Updated May 2023