Delirium treatment.

• Delirium treatment requires a holistic multi-disciplinary approach and      comprehensive medical and physical assessments looking for reversible underlying causes for the delirium.

• Treatment of underlying medical conditions and infections.

• Review of medications.

• Particular attention to nutrition, hydration and early mobility.

• Expert management of bowel and bladder function.

• Supportive care in a multi-disciplinary care setting.

• Cautious use of low dose sedative and anti-psychotic medications for aggression, agitation and distressing psychosis (paranoid delusions, hallucinations).

• Reorientation with familiar objects around the bedside usually help and can reduce the duration and intensity of in-hospital delirium.  These include: A clock, calendar, family photos, favourite magazines, favourite music.  Music therapy is very soothing and settling for agitated confused elderly patients.

• Note that the brain CAT scan is usually normal in delirium, as the acute confusion is usually caused by something below or outside the brain, but impinging on the brain such as drugs and infection.

• Ensuring good hydration and nutrition.

• Safe swallowing sitting upright and forward to reduce the risk of silent aspiration.

• Good mouth care with Sodium Bicarb mouthwashes, Lanolin to lips and Nystatin drops for oral thrush when necessary.

• Speech pathology assessment of safe swallowing.

• Correcting sensory deficits with appropriate hearing aids, glasses and adequate lighting.

• Avoiding sleep disruption.

• Absolutely avoiding any daytime naps which will further worsen the sleep/wake cycle.

• A quiet, dark room with limited interruptions by staff to encourage sleep at night.

• Early mobility with physiotherapy to prevent the complications of prolonged bed rest and immobility.

• Active treatment of constipation to avoid urinary retention and bowel obstruction.

• Avoiding indwelling catheters in bladder unless absolutely necessary.

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.