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PRINCIPLE 2: Delirium risk identification and prevention strategies

Older people will be assessed for delirium risk. Interventions will be put in place for prevention of identified risks. Identified risks will be communicated to the older person, their carer, family and staff involved in their care.

Delirium risk assessment

Delirium risk assessment should be performed in conjunction with cognitive screening.

Delirium Risk Assessment Tool

Use the Delirium Risk Assessment Tool (DRAT) to assess delirium risk for hospitalised older people (1,2). This tool identifies key risk factors that predispose an older person to delirium and risk factors that may precipitate delirium and recommends further investigations, if there is a change in behaviour.

Implement specific strategies, following the identification of delirium risk factors to minimise the risk. Further investigations should be conducted if there is a change in behaviour to identify and address the cause of delirium.

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If your patient is > 70 yrs and has at least one of the above risk factors = RISK of Delirium

Warning - these factors increase risk:

  • Mechanical restraint
  • Malnutrition
  • Three new medications added during hospitalisation
  • IDC (indwelling catheter)
  • An iatrogenic event (such as a procedure, infection, complication, and/or fall).

Other risk assessment tools

Other risk assessment tools may be useful to assess risks for older people in hospital such as the Waterlow risk assessment scale (3), Falls Ontario modified STRATIFY Sydney scoring, Falls Risk Assessment and Management Plan (FRAMP) (4).

These tools consider mental status/ neurological deficit as part of their assessment and complement the DRAT and cognitive screening.

References

  1. NSW Agency for Clinical Innovation. Cognitive Assessment of the Older Person. 2012.
  2. NSW Health, District NSLH. Delirium Risk Assessment Tool (DRAT).
  3. Waterlow J. The Waterlow Score 2005-2007. Available from: http://www.judy-waterlow.co.uk/ waterlow_score.htm.
  4. Clinical Excellence Commission. Falls Risk Assessment and Management Plan (FRAMP) SMR060.912. In: Health N, editor. Sydney: State Health Forms; 2013.
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