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.

Resources and useful links

Delirium risk identification and management

Delirium Screen for Older Adults
This NSW State wide form incorporates the Abbreviated Mental Test scores (AMTS), Delirium Risk Assessment Tool (DRAT) and the Confusion Assessment Method (CAM). It can be ordered through Stream Solutions.

Preventive strategies for delirium
A flowchart of preventive strategies (which can be printed as PDF or posters), adapted from the Clinical practice guidelines for the management of delirium in older people (2006).

Delirium “alerts” and prevention strategies for hospital staff

See examples below adapted by hospitals:

Delirium alert and strategies (Southern NSW Local Health District)
Delirium alert and prevention strategies (Lismore hospital)
Delirium prevention strategies (South Western Sydney Local Health District)
Overview developed by the South Western Sydney Local Health District
Delirium management (2013)
Overview of delirium assessment (including CAM) and management
Delirium resource card
Overview of delirium assessment (including CAM) and management produced by the Canadian Regional Geriatric Program Central (2003)

Lanyard cards

Lanyard cards can be created and attached to staff ID to assist with increasing the awareness of delirium and dementia. Examples:

List of publications

These published articles report studies of interventions to identify and/or manage delirium in hospitals:

Bedside Nurse-Patient Interactions do not Reliably Detect Delirium: An Observational Study (Abstract Only)
Mistarz R, Eliott S, Whitfield A, Ernest D (2011). Australian Critical Care, Volume 24, Issue 2, Pages 126-132, May 2011.
Beyond Grand Rounds: A Comprehensive and Sequential Intervention to Improve Identification of Delirium
Ramaswamy R Dix EF, Drew JE, Diamond JJ, Inouye SK and Roehl BJO (2010) The Gerontologist Vol. 51, No. 1, 122–131 doi:10.1093/geront/gnq075.
Delirium in Australian Hospitals: A Prospective Study
Travers C, Byrne GJ, Pachana NA, Klein K, and Gray L (2013)
Delirium in Elderly General Medical Inpatients: A Prospective Study (Abstract Only)
Iseli RK, Brand C, Telford M and LoGiudice (2007) Internal Medicine Journal 37 (2007) 806–811
Delirium in Older People
Young J, Inouye SK (2007) BMJ 2007;334:842-6
Delirium Unit: Our Experience (Abstract Only)
Dorothy Milly Wong Tin Niam, John AA Geddes, Charles A Inderjeeth (2009). Australasian Journal on Ageing, Volume 28, Issue 4, pages 206–210, December 2009.
Does this Patient Have Delirium? Value of Bedside Instruments
Wong CL, Holroyd-Leduc J, Simel DL, Straus SE. JAMA. 2010 Aug 18;304(7):779-86.
Evaluation and Management of Delirium in Hospitalized Older Patients
Miller MO (2008). Am Fam Physician. 2008 Dec 1;78(11):1265-1270.
Hypnotics’ Association with Mortality or Cancer: a Matched Cohort Study
Kripke DF, Langer RD, Kline LE (2012). BMJ Open 2012; 2:e000850. doi:10.1136/bmjopen-2012-000850.
Identification and Management of In-Hospital Drug-Induced Delirium in Older Patients
Catic AG. (2011). Drugs Aging. 2011 Sep 1;28(9):737-48.
Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients
Guenther U, Weykam J, Andorfer U, Theuerkauf N, Popp J, Ely E.W and Putensen C (2012) Am J Crit Care 2012;21:e12-e20 doi: 10.4037/ajcc2012735.
Management of Delirium: A Clinical Governance Approach
Kulh MA, Mumford VA, Sorensen R and Budge MM (2005). Aust Health Rev 2005: 29(2): 246–252.
Practical Guidelines for the Acute Emergency Sedation of the Severely Agitated Older Patient (Abstract only)
Peisah C, Chan DK, McKay R, Kurrle SE, Reutens SG. (2011). Internal Medicine Journal, Volume 41, Issue 9, pages 651–657, September 2011.