First-line management of delirium includes which approach?

First-line management of delirium includes which approach?

• A. Behavioral interventions and environmental optimization
• B. Antipsychotics
• C. Physical restraints
• D. High-dose sedatives

Answer: (A)

Delirium improves first with nonpharmacologic strategies that optimize the patient’s environment and address reversible contributors. This means reorienting the patient, promoting a stable day–night rhythm, ensuring access to glasses and hearing aids, providing familiar objects, and involving family for reassurance. It also includes ensuring adequate hydration and nutrition, managing pain, promoting mobility, minimizing sleep disruption and sensory overload, and reviewing medications to remove those that can precipitate delirium. These steps reduce confusion and agitation without the risks of sedation. Antipsychotics or sedatives are not first-line and are reserved for persistent, severe agitation or safety concerns after nonpharmacologic measures are tried. Physical restraints are avoided because they can worsen delirium and cause harm. In short, start with behavioral and environmental optimization, then consider pharmacologic options only if necessary for safety.

Delirium improves first with nonpharmacologic strategies that optimize the patient’s environment and address reversible contributors. This means reorienting the patient, promoting a stable day–night rhythm, ensuring access to glasses and hearing aids, providing familiar objects, and involving family for reassurance. It also includes ensuring adequate hydration and nutrition, managing pain, promoting mobility, minimizing sleep disruption and sensory overload, and reviewing medications to remove those that can precipitate delirium. These steps reduce confusion and agitation without the risks of sedation. Antipsychotics or sedatives are not first-line and are reserved for persistent, severe agitation or safety concerns after nonpharmacologic measures are tried. Physical restraints are avoided because they can worsen delirium and cause harm. In short, start with behavioral and environmental optimization, then consider pharmacologic options only if necessary for safety.