Tips for Preventing Delirium in Patients

Ensuring eyeglasses, hearing aids, listening amplifiers

Ambulating at least twice a day if possible

Progressively Lowered Stress Threshold Model (PLST)

Tailored cognitive activities to individual's interests and mental status

Pain management, medication review, sleep enhancement, environmental normalization

Infections, medications, surgery, and dehydration

Nurses can implement strategies like frequent reorientation, early mobilization, and promoting quality sleep.

Using natural light, reducing noise levels, and promoting a normal sleep-wake cycle

Encouraging early ambulation and physical activity

Engaging patients in cognitive activities, puzzles, and memory exercises

Age greater than 65 years, severe illness or comorbidity burden, inadequate control of pain

Regularly reorienting the patient to person, place, and time

Improving lighting in the patient's room and providing glasses or hearing aids when needed

Encouraging regular physical activity and walking

Engaging the patient in puzzles, memory games, or meaningful conversations

Social isolation, noise, overcrowding, lack of privacy, unfamiliar caregivers, and exposure to aggressive behaviors

By promoting restful sleep, providing orientation cues, maintaining hydration, and ensuring proper nutrition

Creating a calm and quiet environment, minimizing noise and distractions, providing soothing music, and using natural light

By encouraging regular physical activity, promoting safe ambulation, and preventing falls

Cognitive stimulation activities can help maintain cognitive function, prevent boredom, and reduce confusion

Physiological needs such as hunger or pain, mood, physical environment

By modifying proximal factors that interfere with sleep, such as noise and frequent awakenings, to meet the need for rest and decrease agitation or aggression.

Optimizing physical environment factors like light, noise, and temperature.

By structuring daily living to maximize remaining abilities and support limitations, thus promoting movement and engagement.

By maximizing abilities to make choices and engaging in shared decision making to the extent possible.

Metabolic encephalopathy, toxic psychosis

Early accurate assessment and identification

Sensory enhancements can help prevent delirium by providing a more stimulating environment.

Enhancing mobility can prevent delirium by promoting physical activity and reducing immobility-related risks.

Cognitive stimulation can help prevent delirium by keeping the brain active and engaged.

Delirium onset is sudden and abrupt, whereas depression onset is recent and may relate to a life change.

Delirium course is fluctuating, often worse at night, while depression course is fairly stable and may be worse in the morning.

In delirium, consciousness is reduced, while in depression, consciousness is clear.

In delirium, psychomotor activity can be increased, decreased, or mixed, while in depression, it is variable with agitation or retardation.

Delirium duration ranges from hours to weeks, while depression duration is variable and may be chronic.

In delirium, attention is disordered and fluctuates, while in depression, attention is most often not impaired.

In delirium, orientation is usually impaired, while in depression, orientation is usually normal.

In delirium, speech is often incoherent, slow, or rapid; may repeat phrases, while in depression, speech may be slow.

In delirium, affect is variable and may look disturbed or frightened, while in depression, affect may be flat.

Dementia onset is insidious, slow, over years, and often unrecognized until deficits are obvious.