This NICE guideline covers the care of adults (18 and over) with, or at risk of, delirium in hospital and in long-term residential care or a nursing home.
Delirium is a common, complication of hospitalisation in elderly people, affecting about one third of older patients admitted to medical wards. Delirium is associated with mortality rates of 25% – 33%, increased morbidity, functional decline and the need for institutional care. Evidence indicates that delirium can be prevented in about one third of patients, although these interventions are not yet routinely available in the NHS.
Note: It is not concerned with people receiving end-of-life care, or people under the influence of or withdrawing from drugs or alcohol (known as delirium tremens).
Interventions to prevent delirium are summarised as:
- Ensuring people at risk of delirium are cared for by a team of healthcare professionals who are familiar to the person at risk (i.e. do not change staff excessively during the person’s stay in hospital or long term care).
- Avoiding moving people within and between wards or rooms unnecessarily.
- Within 24 hours of admission, assessing people at risk for the following clinical factors that might precipitate delirium:
- Cognitive impairment and/or disorientation.
- Dehydration and/or constipation.
- Immobility or limited mobility.
- Multiple medications.
- Poor nutrition.
- Sensory impairment.
- Sleep disturbance.
NICE clinical guideline CG103. Delirium: diagnosis, prevention and management. London: National Institute for Health and Clinical Excellence, 2010.
Tools for Implementation of this Guideline
NICE has developed tools to help organisations implement this guidance:
General Clarification of this Guideline
Professor John Young and colleagues have written an overview of this guideline. Read more: Diagnosis, prevention, and management of delirium: summary of NICE guidance by Young [et al].
Young, J. Murthy, L. [and] Westby, M. [et al] (2010). Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ, July 28th 2010, Vol.341, c3704.