Treating delirium – find the causes, care for the person

Delirium is treated by finding and treating its causes – usually several at once – while protecting the person from harm and distress. This page covers non-ICU care, anchored to SIGN 157 and NICE guidance.

First: confirm and communicate

Assess with the 4AT and full clinical assessment of mental status. Tell the patient and family what delirium is: common, frightening, and it usually improves as the causes are treated. Document the diagnosis and the 4AT score in the notes.

Hunt the causes – systematically; expect more than one

• Drugs – new, changed or stopped (especially anticholinergics, opioids, benzodiazepines); consider alcohol or benzodiazepine withdrawal.
• Infection – assess properly; do not diagnose a urinary tract infection on a dipstick alone in older people.
• Urinary retention and constipation – examine; bladder scan.
• Pain – often under-treated; treat it.
• Dehydration, electrolytes, glucose, hypoxia – check and correct.
• New neurological signs or unexplained drowsiness – examine and escalate.

Non-drug measures

Prioritise consistent staff assignment to build familiarity and reduce patient distress. Actively involve family members in care, as their presence is often the most effective way to reorient and calm a patient. Ensure the environment is safe, well-lit, and quiet, and conduct regular assessments of the patient's capacity to participate in their own care decisions.

Medication

There is no specific pharmacological cure for delirium. Sedation carries significant risks, including worsening confusion and increasing fall hazards. Antipsychotics should be reserved strictly for cases of severe distress or immediate danger to the patient or others, and only after all non-pharmacological strategies have been exhausted. Always use the lowest effective dose for the shortest possible duration. Follow local and national guidance, and review the need daily.

Before discharge

Before discharge, ensure the patient is clinically stable and the primary cause of the delirium has been addressed. Provide a clear summary of the episode in the discharge letter, review the patient's cognitive status, and ensure that both the patient and their family have a clear understanding of what occurred and any necessary follow-up steps.