Table 3.

National Institute for Health and Care Excellence (NICE) guidelines - risk factors and interventions to prevent delirium¹⁷

Risk factors
Age 65 years or older
Cognitive impairment (past or present) and/or dementia
Current hip fracture
Severe illness (a clinical condition that is deteriorating or is at risk of deterioration)
Interventions to prevent delirium
Clinical factor	Preventative intervention
Cognitive impairment or disorientation	• Provide appropriate lighting and clear signage. A clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk.
	• Reorientate the person by explaining where they are, who they are, and what your role is.
	• Introduce cognitively stimulating activities (for example, reminiscence).
	• Facilitate regular visits from family and friends.
Dehydration or constipation	• Encourage the person to drink. Consider offering subcutaneous or intravenous fluids if necessary.
	• Seek advice if necessary when managing fluid balance in people with comorbidities (for example, heart failure or chronic kidney disease).
Hypoxia	• Assess for hypoxia and optimise oxygen saturation if necessary.
Immobility or limited mobility	• Encourage the person to:
	○ mobilise soon after surgery
	○ walk (provide walking aids if needed – these should be accessible at all times).
	• Encourage all people, including those unable to walk, to carry out active range-of-motion exercises.
Infection	• Look for and treat infection.
	• Avoid unnecessary catheterisation.
	• Implement infection control procedures in line with ‘Infection control’ (NICE clinical guidance 2).
Multiple medications	• Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications.
Pain	• Assess for pain. Look for non-verbal signs of pain, particularly in people with communication difficulties.
	• Start and review appropriate pain management in any person in whom pain is identified or suspected.
Poor nutrition	• Follow the advice given on nutrition in ‘Nutrition support in adults’ (NICE clinical guidance 32).
	• If the person has dentures, ensure they fit properly.
Sensory impairment	• Resolve any reversible cause of the impairment (such as impacted ear wax).
	• Ensure working hearing and visual aids are available to and used by people who need them.
Sleep disturbance	• Avoid nursing or medical procedures during sleeping hours, if possible.
	• Schedule medication rounds to avoid disturbing sleep.
	• Reduce noise to a minimum during sleep periods.

National Institute for Health and Clinical Excellence [17]. Adapted from CG 103 Delirium: diagnosis, prevention and management. London: NICE. Available from http://guidance.nice.org.uk/CG103. Reproduced with permission.