Preventing Delirium 101: Avoid Precipitants
Lesson Progress
0% Complete
Avoid known delirium precipitants in high-risk patients
Untreated Pain
- Use opioid alternatives whenever possible
Minimize medications known to precipitate delirium
- Anticholinergics including first-generation antihistamines and muscle relaxants
- Benzodiazepines and other sedative-hypnotics
- Corticosteroids
- H2-receptor antagonists
- Meperidine
Avoid unnecessary tethers
- Foley catheters
- Tethering telemetry cables
- Blood pressure cuffs
NOTE
Let’s elaborate:
Mouzopoulos G, et al. J Orthop Traumatol. 2009;10(3):127–133
Pain management in patients with acute pain (eg, hip fracture, rib fracture)
- Use opioid alternatives
- Acetaminophen as first line
- Consider nerve blocks where appropriate
- Use of fascia iliaca block for patients with hip fracture may ↓ delirium
- For patients with severe dementia
- Consider scheduling analgesia (eg, scheduled acetaminophen)
- Use dementia-specific pain scales
- For patients who do require opioids, start low and go slow
2019 Updated AGS Beers Criteria®. J Am Geriatr Soc. 2019;67(4):674–694
High-risk medications
- Table 3 (“Drug-Disease or Drug-Syndrome Interactions That May Exacerbate the Disease or Syndrome”; Delirium section)
- Table 7 (“Drugs With Strong Anticholinergic Properties”)
References
2019 Updated AGS Beers Criteria®. J Am Geriatr Soc. 2019;67(4):674–694.
Mouzopoulos G, et al. J Orthop Traumatol. 2009;10(3):127–133.