Prevention

To date, the effect of primary preventive strategies on the incidence of delirium in elderly patients has been little researched, and such studies as have been carried out have not identified any interventions that significantly reduce the risk of delirium ( Chapter.4.1.2). However, since a number of patient- and hospital-related factors are known to predispose to delirium in elderly inpatients, the focus of preventive medical and nursing care should be to minimize exposure to these influences. Careful prescribing is important, avoiding where possible any drugs with known deliriogenic potential, particularly in at-risk individuals such as those with Alzheimer's disease. There should be regular review of the drug chart, with the aim of keeping the number of drugs to the minimum necessary. The ward routines and environment should aim to minimize sensory impairment and sleep deprivation, and non-pharmacological sleep-promotion strategies should be used in preference to hypnotic drugs. Patient mobility should be encouraged, as should adequate food and fluid intake. In surgical patients, good preoperative, perioperative, and postoperative care (especially with regard to blood pressure and oxygenation) will reduce the risk of postoperative delirium. It is surprising how difficult it can be to put some of these sensible preventive measures into practice in the modern hospital environment.

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