8 - How to prevent delirium?

Summary

Introduction

It is estimated that we can prevent 30% of delirium in a general hospital. In critical care we are often dealing with and treating consequences of illnesses or their complications. When it comes to delirium, however, we need to focus on prevention as the core strategy. The expression ‘prevention is better than cure’ being very much the case. Current prevention tactics are based on the risk factors outlined in Chapter 5.

Successfully preventing delirium

The few studies that have looked at the prevention of delirium have included elderly patients admitted following a fractured neck of femur, or other general medical conditions. These studies provide a disparate group of interventions. The landmark study done by Inouye et al. was published in the New England Journal of Medicine in 1999. In an elderly population (the average age was 80 ± 6 years), they attempted to address some of the problems from previous studies such as small samples, use of non-targeted interventions and relatively insensitive outcome measures. Moreover, they set out to compare matched patients, with one receiving the interventions and one the usual care.

When allocated to the intervention group, the patient was entered into ‘The Elder Life Program’. This addressed six factors thought to be modifiable in clinical practice, using a predefined protocol for each (Table 8.1).