Table 3 National Institute for Health and Care Excellence (NICE) guidelines - risk factors and interventions to prevent delirium ¹⁷

Age 65 years or older

Cognitive impairment (past or present) and/or dementia

Current hip fracture

Severe illness (a clinical condition that is deteriorating or is at risk of deterioration)

Interventions to prevent delirium

Clinical factor

Preventative intervention

Cognitive impairment or disorientation

• Provide appropriate lighting and clear signage. A clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk.

• Reorientate the person by explaining where they are, who they are, and what your role is.

• Introduce cognitively stimulating activities (for example, reminiscence).

• Facilitate regular visits from family and friends.

Dehydration or constipation

• Encourage the person to drink. Consider offering subcutaneous or intravenous fluids if necessary.

• Seek advice if necessary when managing fluid balance in people with comorbidities (for example, heart failure or chronic kidney disease).

Hypoxia

• Assess for hypoxia and optimise oxygen saturation if necessary.

Immobility or limited mobility

• Encourage the person to:

○ mobilise soon after surgery

○ walk (provide walking aids if needed – these should be accessible at all times).

• Encourage all people, including those unable to walk, to carry out active range-of-motion exercises.

Infection

• Look for and treat infection.

• Avoid unnecessary catheterisation.

• Implement infection control procedures in line with ‘Infection control’ (NICE clinical guidance 2).

Multiple medications

• Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications.

Pain

• Assess for pain. Look for non-verbal signs of pain, particularly in people with communication difficulties.

• Start and review appropriate pain management in any person in whom pain is identified or suspected.

Poor nutrition

• Follow the advice given on nutrition in ‘Nutrition support in adults’ (NICE clinical guidance 32).

• If the person has dentures, ensure they fit properly.

Sensory impairment

• Resolve any reversible cause of the impairment (such as impacted ear wax).

• Ensure working hearing and visual aids are available to and used by people who need them.

Sleep disturbance

• Avoid nursing or medical procedures during sleeping hours, if possible.

• Schedule medication rounds to avoid disturbing sleep.

• Reduce noise to a minimum during sleep periods.