Table 5.

Suggested adaptations to delirium prevention interventions for individuals with dementia

Targeted risk factor	Interventions	Description	Adaptation for dementia
Cognitive impairment	Orientation protocol	Orientation board with names of care team members and daily schedule; orienting communication once a day	Orientation protocol three times a day; education for staff in special approaches to communication with individuals with dementia
	Therapeutic activities	Cognitive stimulation activities three times a day (customized selection according to leisure interests and physical impairments)	Additional customization for the selection of activities according to level of cognitive function
Immobility	Early mobilization	Walking or active range-of-motion exercises three times a day; minimizing use of immobilizing equipment and physical restraints	For all tasks, focus on one-step, as opposed to multistep, instructions
Vision impairment	Vision protocol	Providing visual aids and adaptive equipment, with daily reinforcement	For all tasks, focus on one-step, as opposed to multistep, instructions
Hearing impairment	Hearing protocol	Providing portable amplifying devices; earwax disimpaction; special communication techniques, with daily reinforcement	For all tasks, focus on one-step, as opposed to multistep, instructions
Dehydration	Oral volume repletion	Early recognition of dehydration and oral volume repletion; encouragement during meals	For all tasks, focus on one-step, as opposed to multistep, instructions
Sleep deprivation	Non-pharmacological sleep protocol	At bedtime, warm drink, relaxation music or sounds, and massage; unit-wide noise reduction programme; rescheduling medications and procedures to allow uninterrupted sleep	Importance of behavioural (for example, avoid caffeine and diuretics after mid-day) and environmental changes to enhance sleep (for example, darkened, quiet room, minimize interruptions)
Polypharmacy and inappropriate medications	Psychoactive medications protocol	Screen medications daily; minimize medications listed in AGS Beers Criteria and psychoactive medications; discuss strategies with an interdisciplinary team	Avoidance of psychoactive medications even more important for this high-risk group
Other protocols	Nursing interventions	Targeting delirium risk factors (as above) in all patients, with special nursing focus to maintain early mobility, prevent dehydration, avoid psychoactive medications and maximize sleep hygiene; use of non-pharmacological approaches for sleep, anxiety or pain	Daily delirium screens with medical work-up as indicated; minimizing psychoactive medications; non-opioid treatments for pain; educating patients, families and staff about behavioural management in dementia and sundowning
	Provider education	Educational programme about delirium and delirium prevention	Educational programme about delirium superimposed on dementia; special needs of dementia patients; behavioural management of agitation
	Emotional support	Nursing, chaplaincy, social work support	Include family and informal caregivers