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Table 4. Non-Pharmacologic Delirium Prevention (based on the
HELP program)
Risk Factor Intervention
Cognitive Impairment • Multiple times per day reality orientation – board
with names of care-team members and day's schedule;
communication to reorient to surroundings
• Daily Activities for cognitive stimulation and socialization
(e.g. discussion of current events; word games; discussion of
past using resident's own or other pictures; reading ; music;
games with props)
Sleep Deprivation • Non-pharmacological sleep enhancement strategies –
back rub, warm drink, warm blanket, and relaxing music
• Noise reduction strategies
• Uninterrupted scheduled sleep
Immobilization • Daily "head-to-toe" physical activity at resident's max
ability, including active range of motion, walking, chair
stands
• Minimizing immobilizing equipment (e.g. restraints,
bladder catheters)
Vision Impairment • Vision aids (e.g. glasses or magnifying lenses)
• Adaptive equipment (e.g. large print, large numbers on
telephone/ remote control)
Hearing Impairment • Amplifying devices
• Adaptive equipment
• Cerumen disimpaction
Dehydration/
undernutrition
• Early recognition and volume repletion
• Assistance and companionship during meals
STEP 4: Screen for delirium with a validated instrument
such as the Confusion Assessment Method (CAM)
➤ CAM has a sensitivity of 94–100% and a specificity of 90–95%.
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➤ Included in MDS 3.0.
Assessment
