Evidence for Single-Component NPI Management of Delirium

Doll Therapy

  • Alleviates distress and promotes comfort in some people with dementia
  • Promotes well-being, reduction in challenging behaviors, and increased dietary intake

Mitchell G, et al. and Mitchell G.

The use of doll therapy in dementia care appears to be increasing, even though there is limited empirical evidence to support its use and therapeutic effectiveness.

Current evidence suggests that engagement with dolls can promote well-being. This has been described in the literature as a reduction in challenging behavior, greater engagement with others, and even increased dietary intake.

Therapeutic Activity Kits

  • Divert attention away from difficult-to-manage behaviors while meeting cognitive and psychosocial needs
  • Reduce helplessness and frustration in the patient and caregiver

Ricker JR, et al.

Activity kits contain 9 evidence-based activities: word-search puzzles, doodling, coloring, reminiscence cards, playing cards, color-changing egg, towel folding, the baby doll, and music.

The Geriatric Emergency Department documented 47 successful uses of the activities as first-line nonpharmacologic management of dementia-related behaviors within the first month of implementation.

Morning Bright-Light Therapy

  • Normalizes disturbed sleep and wakefulness cycle in older people with dementia and improved bed rest
  • Improves sleep and functional outcomes in delirious older hospitalized adults
  • Useful for reducing postoperative delirium

Lyketos, et al.

Prior research has suggested that bright light therapy (BLT) may reduce agitated behaviors in dementia patients. The aim of this study was to test the efficacy of BLT in a randomized, controlled, crossover clinical trial.

Patients with dementia [in chronic care] who exhibit agitated behaviors sleep more hours at night when administered morning BLT. However, BLT does not lead to improvements in agitated behaviors in institutionalized patients with dementia with non‐disturbed sleep–wake cycles.

Chong MS, et al.

Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults.

This study shows initial evidence for the clinical benefits (longer total sleep time, increased first sleep bouts “SB” length, and functional gains) of incorporating bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies

Ono, H.

We conclude that postoperative bright light exposure adjusted the sleep-wakefulness cycle and improved the bed rest of patients. It was also indicated that bright light therapy is useful for reducing postoperative delirium.

Music Therapy

Reduces agitation, disruptiveness, and prevents medication increases in people with dementia


Chong MS, Tan KT, Tay L, Wong YM, Ancoli-Israel S. Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults. Clin Interv Aging. 2013;8:565–572. doi:10.2147/CIA.S44926

Gomez Gallego M, Gomez Garcia J. Music Therapy and Alzheimer’s disease: Cognitive, psychological, and behavioural effects. Neurologia. 2017;32:300-308.

Gómez-Romero M, Jiménez-Palomares M, Rodríguez-Mansilla J, et al. Benefits of music therapy on behaviour disorders in subjects diagnosed with dementia: a systematic review. Neurologia. 2014;S0213-4853(14)00248-5. doi: 10.1016/j.nrl.2014.11.001

Lyketos, et al. A RCT of BLT for agitated behaviors in LTC 1999

Mitchell G, et al. Br J Nurs. 2013;22(6):329–334.

Mitchell G. Nurs Older People. 2014;26(4):24–26.

Ono, H. BLT after oesphaetcomy

Ricker JR, et al. Geriatric Nursing. 2017;38(6):604–605.

Shiltz DL, Lineweaver TT, Brimmer T, et al. “Music First” An Alternative or Adjunct to Psychotropic Medications for the Behavioral and Psychological Symptoms of Dementia. GeroPsych. 2017;31(1), 17-30. http://dx.doi.org/10.1024/1662-9647/a000180


NPI, nonpharmacologic intervention