Delirium Hub: Delirium in specific settings and situations

Delirium at the end of life

• End of Life Care in Frailty: Delirium - British Geriatrics Society
  BGS resource on managing delirium at the end of life.
   
• Delirium at the end of life - Age & Ageing (2020) 
  Open Access editorial on managing delirium at the end of life.
   
• Care of dying adults in the last days of life - NICE (2015)
  Guideline on end of life care with a specific section on the management of delirium.
   
• Scottish Palliative Care Guidelines - NHS Scotland/Health Improvement Scotland
  Palliative care guideline with a specific section on delirium (see section on symptom control).
   
• Delirium in adult cancer patients: ESMO clinical practice guidelines - Annals of Oncology (2018)
  Guideline on managing delirium in patients with cancer.

Delirium in the critical care setting

This section contains links to resource hubs with information for practitioners managing delirium in the critical care setting.

• Delirium Resource Centre - London Health Sciences Centre
  Website with extensive resources on delirium in the critical care setting.

Delirium in hospitalised patients

This section contains information on methods to prevent, screen and treat delirium in hospitalised non-ICU patients.

• Delirium: prevention, diagnosis and management in hospital and long-term care - NICE (2010; updated 2023)
  This guideline covers diagnosing and treating delirium in people aged 18 and over in hospital and in long-term residential care or a nursing home. It also covers identifying people at risk of developing delirium in these settings and preventing onset. It aims to improve diagnosis of delirium and reduce hospital stays and complications.
   
• Risk reduction and management of delirium - SIGN (2019)
  SIGN guideline on delirium.
   
• Hospital Delirium Programme and Toolkit - Dementia United
  A toolkit aiming to improve prevention, detection, management and treatment of delirium in hospitals.

Delirium in care homes and community settings

This section gives specific advice for those working with patients experiencing delirium in care home settings or older people living in the community.

• CGA in primary care settings: patients presenting with confusion and delirium - British Geriatrics Society
  Tip sheet for primary care practitioners on managing delirium in the community.
   
• Recognising and preventing delirium - NICE (2020)
  A quick guide for care home managers on recognising and preventing delirium.
   
• Interventions for preventing delirium in older people in institutional long-term care - Cochrane Library (2019).
  A systematic review of interventions for preventing delirium in long-term care which showed limited evidence of benefit from such interventions but recommended further research on multi-component interventions.
   
• Greater Manchester Community Delirium Toolkit - Dementia United
  The Greater Manchester community delirium toolkit is designed for health and social care staff to use in the community to help them identify and manage delirium in adults.

Delirium in the Emergency Department

• Managing delirium and agitation in the older Emergency Department patient: the ADEPT tool - Annals of Emergency Medicine (2020)
  Protocol for the assessment and management of patients with delirium and agitation in the Emergency Department.
   
• Emergency Department Delirium - Vanderbilt University Medical Centre.
  Website on delirium in the ED with links to screening tools which can be used for assessment of delirium.

Perioperative delirium

• Guideline for the care of people living with frailty undergoing elective and emergency surgery that encompasses the whole perioperative pathway - British Geriatrics Society and Centre for Perioperative Care (2021)
  Guideline written jointly by the BGS and CPOC regarding perioperative care of frail, older patients. Includes specific advice on screening, prevention and management on delirium. 
   
• Guidelines for the peri-operative care of people living with dementia - Anaesthesia (2019)
  Guideline for peri-operative management of patients with dementia. Includes specific guidance on delirium.

COVID-19

• Prevalence, incidence and mortality of delirium in patients with COVID-19: a systematic review and meta-analysis - Age and Ageing (2021)
  A meta-analysis of studies of patients with COVID-19, which showed that almost one third of older patients and mortality was 3-fold higher in these patients.
   
• COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study - ISARIC Clinical Characterisation Group (2021) 
  Results from the ISARIC study, including results from almost 100,000 patients, which shows that “confusion” is a common presenting feature of COVID-19 and is the most common atypical presentation in older people, suggesting that delirium is a common manifestation of COVID-19.
   
• Coronavirus: Managing delirium in confirmed and suspected cases - British Geriatrics Society, European Delirium Association and Old Age Psychiatry Faculty/Royal College of Psychiatrists (2020).
  Consensus statement on identification and management of delirium in COVID.