Clinical practice in the treatment of delirium

Delirium is an acute, debilitating and distressing neurocognitive condition that occurs as a result of illness, injury, and hospitalisation, with older people most at risk. This project will ascertain clinicians’ current practice; the degree and nature of their practice change following the publication of evidence that antipsychotics are ineffective for delirium

This study will use a mixed-methods design and behaviour change theory to survey and interview Australian doctors, nurses, and pharmacists about their treatment of delirium, with a focus on the use of antipsychotics.

Delirium is an acute, debilitating and distressing neurocognitive condition that occurs as a result of illness, injury, and hospitalisation, with older people most at risk.

Recommended clinical strategies that prevent delirium in around one in three older patients, with less evidence available that they effectively treat delirium. They are to:

assess the patient
identify and treat underlying risk factors and causes
ensure that they are safe and have sufficient sleep
sensory aids
hydration
physical and cognitive activity, and
advise and reassure the patient and their family.

Recent high-level studies have reported that antipsychotics do not reduce delirium duration, severity, associated distress, or other poorer outcomes. Clinical practice change to reduce the use of antipsychotics for delirious patients is therefore warranted but challenging because delirium can be very distressing for patients, their families, and clinicians. There is uncertainty about the effectiveness of alternative strategies.

This project will ascertain:

clinicians’ current practice
the degree and nature of their practice change following the publication of evidence that antipsychotics are ineffective for delirium, and
what has influenced their current practice and practice change.

The outcome of the project will be evidence- and theory-based recommendations for clinical research in the treatment of delirium.

Publications

Hosie, A., Agar, M., Caplan, G. A., Draper, B., Hedger, S., Rowett, D., Tuffin, P., Cheah, S. L., Phillips, J. L., Brown, L., Sidhu, M., & Currow, D. C. (2021). Clinicians' delirium treatment practice, practice change, and influences: A national online survey. Palliative medicine, 35(8), 1553–1563. https://doi.org/10.1177/02692163211022183