Delirium and Medical Comorbidity

Delirium and Medical Comorbidity equips teams to prevent, detect, and treat acute confusional states across hospital, ICU, and long-term care—where SUD, hepatic/renal disease, infection, and polypharmacy often collide. This page turns evidence into bedside steps: risk screens on admission; non-pharmacologic bundles (sleep, orientation, mobility, glasses/hearing aids); and judicious medication use. If you’re comparing a delirium management conference, you’ll find protocols that coordinate medicine, geriatrics, anesthesia, and psychiatry, plus pathways that distinguish alcohol/benzodiazepine withdrawal from sepsis or metabolic drivers. Because transitions are risky, we link to Consultation-Liaison and SUD for discharge linkage and MOUD/AUD starts.

Delirium is a system problem with person-level consequences. We outline medication reviews that reduce anticholinergic burden and sedative stacking; pain and sleep strategies that avoid respiratory suppression; and communication plans that support family re-orientation without restraint. For refractory hyperactive cases, we describe safety-first pharmacology and environmental controls; for hypoactive forms, we emphasize mobilization and nutrition. Equity requires hearing/vision support, language access, and caregiver inclusion. Programs track incidence, LOS, falls, and 30-day readmissions to drive improvement.

Prevention, Detection, and Treatment

Risk assessment and baseline

  • Screen cognition, sensory deficits, substance history, and meds.
  • Document baseline function to detect changes early.

Non-pharmacologic bundles

  • Normalize day–night cycles, mobility, hydration, and orientation cues.
  • Ensure glasses, hearing aids, and interpreters are available.

Medication stewardship

  • Minimize anticholinergics and sedatives; treat pain without oversedation.
  • Use targeted agents only when safety requires.

Withdrawal vs medical causes

  • Apply symptom-triggered alcohol/benzo protocols when indicated.
  • Run focused workups for infection, hypoxia, metabolic and hepatic issues.

Teamwork, Transitions, and Measurement

CL–medicine co-management
Shared rounds and order sets for consistency.

ICU adaptations
Delirium screens, light and noise control, early mobility.

Family partnership
Coach orientation and sleep support; provide updates transparently.

 

Discharge planning
Link to MOUD/AUD care, rehab, and home supports; schedule follow-ups.

Equity and access
Language services, low-literacy materials, and caregiver training.

Data systems
Track delirium days, restraints, falls, and readmissions.

Education and drills
Micro-learning for staff; escalation scripts for agitation.

Quality improvement
Iterate bundles based on unit-level outcomes.

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