Table 6.

Recommendations for delirium prevention interventions for individuals with dementia

Targeted risk factor	Recommendation
Cognitive impairment	Reorient the patient to members of the care team and daily schedule three times daily Educate staff on special approaches for communicating with individuals with dementia Cognitively stimulating activities, three times daily selected based on personal interest and modified for physical and cognitive abilities Occupational therapy
Vision or hearing impairment	Ensure eyeglasses and hearing aids are worn Provide additional portable-amplifying devices, utilize special communication techniques (such as written communication in large print) Use one-step (as opposed to multistep) instructions for all tasks
Immobility	Early mobilization with ambulation (if able) or active range-of-motion exercises three times a day. Use one-step (as opposed to multistep) instructions for all tasks Minimize the use of immobilizing equipment and physical restraints Engage physical therapy
Dehydration	Oral volume repletion with encouragement of hydration, using one-step (as opposed to multistep) instructions during meals and throughout the day
Sleep deprivation	At bedtime, warm drink, relaxation music or sounds, and massage Minimize interruptions during sleep hours by implementing a unit-wide noise reduction program, darkened rooms, rescheduling medications Use behavioral and environmental sleep-enhancing strategies, such as avoiding food/drinks or medications that may keep patients up at night (i.e., diuretic after afternoon)
Unmanaged pain	Appropriate screening, recognition, and management of pain Avoid opiates which can worsen or cause delirium; use nonpharmacologic approaches where possible
Inappropriate medications	Screen medications daily Minimize the use of medications listed in the AGS Beers Criteria159 and psychoactive medications. This is of particular importance in this patient population
Other	Daily delirium screens with medical workup as indicated Education about delirium superimposed on dementia and the special needs of dementia patients Education for all patients, families, and staff about non-pharmacological management for behavioral symptoms of dementia (sundowning, agitation) Multidisciplinary team involvement is also critical, including chaplains, social work, physical therapy, occupational therapy, nursing, medical providers, family, and informal caregivers

Notes: Most important with all interventions for delirium in patients with dementia is to focus on one-step instructions in all tasks, as opposed to multistep instructions. Multidisciplinary team involvement is also critical, including chaplains, social work, physical therapy, occupational therapy, nursing, and medical providers. Delirium prevention is everyone’s responsibility.