Prevention

A variety of methods for delirium prevention in hospitalized patients have been subjected to controlled evaluations. Cole and coworkers identified ten studies, of which three were randomized, in a systematic review;(l2) patients were middle-aged or elderly medical and surgical cases. Interventions included preintervention psychiatric assessment, and pre- and postoperative nursing assessments. Of these studies, only one showed a significant reduction of delirium in the treated group, but this was a non-randomized study. Therefore it appears that there is little evidence to support the introduction of special measures, over and above routine care, to prevent delirium.

Good general medical and nursing care must be the key to prevention as well as to early recognition and effective treatment. Screening for alcohol dependence is important, for example with the CAGE questions. Elderly patients who are very unwell physically or who are having a major procedure, who have pre-existing cognitive problems, and who are receiving polypharmacy (especially psychoactive drugs) are the most likely to develop delirium, and should be monitored clinically for this condition. Hypnotics are associated with an increased risk of delirium; routine use should be avoided, especially in such vulnerable patients.

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