Synopsis
Treat delirium through urgent cause control and skilled non-drug care, de-escalate distress while preserving communication and mobility, and restrict sedating medicine to exceptional short-term safety indications with Parkinson and Lewy-body safeguards.
- Cause treatment and multicomponent non-drug care are first-line delirium management; no medicine cures the syndrome.
- Use one calm communicator, introduce each action, validate fear, offer simple choices, restore glasses and hearing aids and involve familiar people when wanted.
- Meet physical needs: oxygen when indicated, analgesia, hydration, nutrition, toilet, bowel care, temperature comfort, sleep and safe mobilisation.
Key red flags
Never sedate agitation before checking oxygenation, glucose, pain, retention, constipation, withdrawal, medication toxicity and new neurological signs.
The person is about to cause serious harm or prevent essential life-saving treatment despite skilled de-escalation.
Investigation priorities
Detect a new or untreated medical driver.
Management branches
Delirium is recognised with distress, disorientation or unsafe behaviour.
- Correct physiological and medical drivers and provide pain, hydration, nutrition, bowel, bladder and sensory care.
- Use one calm communicator, familiar support, orientation, low-stimulation space, sleep protection and safe mobilisation.
Key medicines
HaloperidolFor a severely distressed or dangerous frail older adult, a typed local protocol commonly starts 0.5 mg orally once, reassesses after one to two hours and limits total exposure; NICE advises treatment usually for one week or less.
LorazepamFor ordinary delirium avoid routine use; when a specialist identifies catatonia or a specific withdrawal indication, a cautious older-adult test dose may be 0.5 mg orally or parenterally with monitored reassessment.