title: Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice.
abstract: Delirium is highly prevalent in those with serious or advanced medical illnesses. It is associated with many adverse consequences, including significant patient, family, and health care provider distress. This article suggests a novel approach to delirium assessment and management and provides useful, practical guidance for clinicians based on a complete review of the existing literature and the expert clinical opinion of the authors and their colleagues, derived from over a decade of collective bedside experience. Comprehensive assessment includes careful description of observed symptoms, signs, and behaviors; and an understanding of the patient's situation, including primary diagnosis, associated comorbidities, functional status, and prognosis. The importance of incorporating goals of care for the patient and family is discussed. The concepts of potential reversibility versus irreversible delirium and delirium subtype are proffered, with a description of how diagnostic and management strategies follow from these concepts. Pharmacological interventions that provide rapid, effective, and safe relief are presented. Employing both pharmacological and nonpharmacological interventions, including patient and family education, improves symptoms and relieves patient and family distress, whether the delirium is reversible or irreversible, hyperactive or hypoactive. All interventions can be provided in any setting of care, including patients' homes.
authors.affiliation: San Diego Hospice and The Institute for Palliative Medicine, San Diego, CA 92103, USA. scottirwinmd@gmail.com
authors.forename: Scott A
authors.initials: SA
authors.lastname: Irwin
authors.forename: Rosene D
authors.initials: RD
authors.lastname: Pirrello
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Hirst
authors.forename: Gary T
authors.initials: GT
authors.lastname: Buckholz
authors.forename: Frank D
authors.initials: FD
authors.lastname: Ferris
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D003693:Delirium / Q000175:diagnosis* / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D010818:Practice Patterns, Physicians'; D019452:Terminally Ill / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents