Non-pharmacological treatment

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SIGN key recommendations and good practice


Healthcare professionals should follow established pathways of good care to manage patients with delirium.

  • First consider acute, life-threatening causes of delirium, including low oxygen level, low blood pressure, low glucose level, and drug intoxication or withdrawal
  • Systematically identify and treat potential causes (medications, acute illness, etc), noting that multiple causes are common
  • Optimise physiology, management of concurrent conditions, environment (reduce noise), medications, and natural sleep, to promote brain recovery
  • Specifically detect, assess causes of, and treat agitation and/or distress, using nonpharmacological means only if possible (see pharmacological treatment)
  • Communicate the diagnosis to patients and carers, encourage involvement of carers, and provide ongoing engagement and support
  • Aim to prevent complications of delirium such as immobility, falls, pressure sores, dehydration, malnourishment, isolation
  • Monitor for recovery and consider specialist referral if not recovering
  • Consider follow up.

Good practice point

  • Promote cognitive engagement, mobilisation, and other rehabilitation strategies.

Advice on information to provide to family and carers, and suggestions of ways to help.  Booklets are available through the SIGN website.

See the evidence base in section 6 of SIGN 157 here 

TIME bundle

The Triggers, Investigate, Manage, Engage (TIME) bundle covers the first two hours of care. It provides a protocol for good care based on expert consensus.68

Click on this link to open the TIME form in a new window.


About the evidence base

There is insufficient high-quality evidence to determine the efficacy of formal packages of non-pharmacological interventions in reducing the severity or duration of delirium when it does occur.58, 61

Therefore, guidance on treatment of people with delirium relies on expert consensus, which advocates multicomponent interventions as fundamental good practice.58,67,68

Read full details of the SIGN evidence base here pdf pg 24