Delirium can be a distressing process for residents and family members. Picture this, daughter comes in to visit mom every week however, today, mom cannot think very clearly, cannot pay attention, and is not aware of their environmental surroundings. Daughter, rightfully so, is concerned and wants to have mom’s urine checked for a UTI. Sure, the root cause of many cases of delirium are UTIs, however, delirium is usually multifactorial and requires a comprehensive clinical evaluation to determine the root cause. 

In an interesting article published in the “Curbsiders Internal Medicine,” statistically 30-40% of delirium can be prevented, and behavioral strategies may help reduce the severity and duration of delirium. What I wasn’t aware of is that delirium is associated with ongoing brain inflammation and neuronal damage which can increase the rate of dementia, functional decline, and institutionalization. Wow! So, what can we do to address delirium before it starts or even after the resident is symptomatic? 

• Orientation. Plain and simple. Keep your residents up to date with current events, times and dates, family connections, phone calls, etc.  
• Fluids. With each resident “touch,” begin and/or end with assisting them to drink a glass of water. Hydration is super important!
• Mobility. Immobility can worsen delirium as well as lead to other issues. Although some residents are at high risk for falls, every effort should be made to get them up and moving! Determine what the plan should be for each individual resident to assist in preventing falls! 
• Vision and Hearing Aids. If the resident requires visual or hearing devices, use them! Be sure that their glasses are clean and are the correct prescription. Ensure that batteries are fresh in hearing aids and that all wax build up is removed. It is also important to remember to slow down, speak clearly and slowly even if you feel rushed.  
• Sleep, pain, medications. Limit or deprescribe psychoactive medications when possible. Many times, a resident will return from the hospital with a new antipsychotic order. The hospital likely ordered it to address the resident’s behaviors but once they are reacclimated to their environment they will likely not need it! Remember the importance of sleep and pain when it comes to delirium. Optimize sleep, be sure that residents have uninterrupted sleep during the night and that any signs of pain are addressed timely. 

Remember, delirium loves older people as they have a higher chance of having pre-existing neurocognitive disease. Reducing the severity and duration of delirium can shorten the damage done to the brain and may improve long-term outcomes! Stay well and stay informed!