The Prevention, Diagnosis and Management of Delirium in Older People
British Geriatrics Society, & Royal College of Physicians. (2006).
London (United Kingdom): Royal College of Physicians, (Concise Guidance to Good Practice Series, No. 6), 1-18.
This evidence-based guideline provides recommendations for the prevention, diagnosis, and management of delirium in older adults. The recommendations are not specific to the field of speech-language pathology, however, may be relevant to a speech-language pathologist treating individuals with delirium.
Royal College of Physicians (United Kingdom)
<div>The following is recommended regarding the screening of delirium for older adults in hospital and community care settings:</div>
<ul>
<li>cognitive measures should be completed for all elderly patients admitted to the hospital (Grade C Evidence);</li>
<li>periodical, or serial, measurements should be utilized for patients identified to be with or at risk for delirium in order to aid in the detection of the development or resolution of delirium (Grade B Evidence);</li>
<li>patient history regarding the onset and course of confusion from a relative or carepartner should be obtained to help distinguish between delirium and dementia (Grade C Evidence);</li>
<li>use of the Confusion Assessment Method (CAM) screening method can allow for the quick and accurate diagnosis of delirium by non-psychiatrically trained clinicians (Grade B Evidence); and</li>
<li>patients identified to be at high risk for delirium should be identified upon admission and prevention strategies should be incorporated into their care plan (Grade A Evidence).</li>
</ul>
<div>The following is recommended regarding the treatment of older adults with delirium in hospital and community care settings: </div>
<ul>
<li>corroboration of patient history should be obtained from relatives, medical providers, care partners, or any confirmed sources with good knowledge of the patient whenever possible due to potential for being poor historians (Grade C Evidence);</li>
<li>patients should be provided with a "good sensory environment and with a reality orientation approach" (p. 3), with care provided by a multidisciplinary team (Grade C Evidence); and</li>
<li>regular audits should be conducted regards the processes and outcomes of patients with delirium (e.g., cognitive outcomes, number of room changes, length of stay, adverse events, and mortality) and results of the audit should be used as feedback on performance in order to target potential educational programs (Good Practice Point).</li>
</ul>
