The evidence is limited: 3 low-quality studies were found, each of which was unrepresentative either of the population or the medication used, but there was some indication of clinical effectiveness. Pharmacological agents may be a simple preventive treatment for delirium, but there is uncertainty about effectiveness and side effects so they should be used with caution. The serious nature of delirium and its consequences makes it important to establish all methods of prevention. This includes nursing homes and residential homes. Residential care in a home that may include skilled nursing care and help with everyday activities. Hypoactive deliriumĪ subtype of delirium characterised by people who become withdrawn, quiet and sleepy.
Hyperactive deliriumĪ subtype of delirium characterised by people who have heightened arousal and can be restless, agitated or aggressive. Health professionals regulated or licensed with a professional body to provide care and support, for example, generalist and specialist doctors registered with the General Medical Council, and nurses registered with the Nursing and Midwifery Council. This could include registered nurses and care workers (also called care assistants or support workers), social workers, therapists, case managers, GPs, lead clinicians, community nurses and allied professionals, such as physiotherapists, occupational therapists and dietitians. Health and social care staff across the wider care team. This section defines terms that have been used in a particular way for this guideline. Take into account the Medicines and Healthcare products Regulatory Agency’s advice about the risks of using haloperidol for the acute treatment of delirium in older people, including the risks of cardiac and neurological side effects (especially in people living with Parkinson’s disease or dementia with Lewy bodies). Start at the lowest clinically appropriate dose and titrate cautiously according to symptoms. If a person with delirium is distressed or considered a risk to themselves or others, and verbal and non-verbal de-escalation techniques are ineffective or inappropriate, consider giving short-term haloperidol (usually for 1 week or less). Distress may be less evident in people with hypoactive delirium, who can still become distressed by, for example, psychotic symptoms. For more information on de-escalation techniques, see the NICE guideline on violence and aggression. If a person with delirium is distressed or considered a risk to themselves or others, first use verbal and non-verbal techniques to de-escalate the situation.
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