Can Delirium Be Prevented?

A fellow caregiver asked...

Can delirium be prevented?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

Yes, studies have shown that it's sometimes possible to prevent delirium, especially in those people who are most at risk of developing it (the elderly and those with dementias such as Alzheimer's). Experts estimate that 30 to 40 percent of delirium that occurs in the hospital may be preventable.

These seemingly minor actions have proven useful in preventing delirium in large hospitals:

  • Making sure patients are given their eyeglasses and hearing aids

  • Providing clocks as well as extra reminders and explanations to improve orientation ("You are in the hospital, you've had hip surgery, today is Monday, and the month is June.")

  • Getting patients out of bed and walking as soon as possible (being forced to stay in bed can tip some people into delirium)

  • Promoting sleep by minimizing noise, blood draws, and blood pressure checks at night and in the early morning, rather than using sleeping pills (Obviously a patient or caregiver can't control these factors, but you can ask why sleep meds are needed and whether they can be avoided through measures like these.)

  • Avoiding dehydration by encouraging the person to sip water and other fluids, rather than relying on intravenous hydration

Another study found that for elders hospitalized after hip surgery, the involvement of a geriatric consultation team (a team specializing in optimizing the care of older adults) substantially reduced delirium. Among other things, the geriatric team focused on pain management, bowel and bladder function, nutrition, and reducing medications that can affect the brain.

Unfortunately, no medication has been found to reliably help prevent delirium.

Delirium is most easily prevented when an elder's hospital care is provided by trained staff, such as those in Acute Care for Elders (ACE) units, geriatric consultation teams, or even specially trained volunteers. Not all hospitals provide these specialized services, however. Fortunately, family members and concerned caregivers can always be helpful in providing a sick elder with glasses, hearing aids, and a reassuring and familiar presence. Caregivers are often among the first ones to notice if a loved one is developing delirium in the hospital; bringing the condition to the doctor's attention is extremely important.