Prevention of delirium in the medical wards

Delirium complicates the hospitalization of up to 54% of medical inpatients, but up to 40% of incident delirium is preventable. Primary prevention of delirium in medical wards can be achieved through protocolized, interdisciplinary, multicomponent nonpharmacologic interventions that involve the bedside nurse, often an advance-practice nurse, the family, and, where available, trained volunteers, in addition to the medical team. The physician’s role is to assess and (whenever possible) correct risk factors through a careful history, physical examination, and screening laboratory tests. These assessments include cognitive and functional assessment and a careful review of medications, eliminating or reducing the doses of those known to contribute to delirium. At present, there are no proven pharmacologic delirium-prevention measures, although melatonin holds promise as an adjunct in prevention. Once delirium has occurred, secondary and tertiary prevention take over to prevent delirium-associated complications.