Recommendations

The following components should be considered as part of a package of care for patients at risk of developing delirium:

• orientation and ensuring patients have their glasses and hearing aids
• promoting sleep hygiene 
• early mobilisation 
• pain control 
• prevention, early identification and treatment of postoperative complications 
• maintaining optimal hydration and nutrition 
• regulation of bladder and bowel function
• provision of supplementary oxygen, if appropriate.

Good practice points

• Ward moves should be avoided wherever possible for patients at risk of delirium
• Prior to surgery patients and carers should be advised of the risk of developing delirium, to alleviate distress and help with management if it does occur
• Where possible, assistance should be sought from a patient’s relatives and carers to deliver care to reduce the risk of delirium developing.

Evidence base 

See the evidence base in section 4.2 here 

There is evidence for effectiveness of the following interventions in reducing risk of delirium:

Multi-component interventions - components vary but consist of some of the following: physiotherapy, reorientation, early mobilisation, identification and treatment of underlying causes or postoperative complications, pain control, regulation of bowel and bladder function, hydration and nutrition, and oxygen delivery.

Comprehensive geriatric care– defined in the evidence as a specialist geriatric orthopaedics team providing comprehensive medical assessment, management and initiation of rehabilitation.

Use of a checklist- may help to embed good fundamental care and reduce incidence of delirium in patients after an operation.

Educating relatives or carers to deliver non-pharmacological multicomponent interventions, such as reorientation.