Orientation strategies during delirium: Are they helpful?

Journal of Clinical Nursing

Volumn 20, Issue 23-24, 2011, Pages 3285-3294

  Day, Jenny ^a   Higgins, Isabel ^a   Keatinge, Diana ^b  

^a NEWCASTLE UNIVERSITY   (United Kingdom)

^b UNIVERSITY OF NEWCASTLE   (Australia)

Author keywords

Acute care; Clinical guidelines; Delirium; Nurses; Nursing; Older people; Orientation

Indexed keywords

ARTICLE; DELIRIUM; HUMAN;

DELIRIUM; HUMANS;

EID: 81155122967     PISSN: 09621067     EISSN: 13652702     Source Type: Journal    
DOI: 10.1111/j.1365-2702.2011.03849.x     Document Type: Article

References (81)

1. Access Economics (2005) Dementia Estimates and Projections for Australian states and Territories. 1-31. Available at: (accessed 10 November 2010).
2. Adamis D, Treloar A, Martin FC & Macdonald AJD (2007) A brief review of the history of delirium as a mental disorder. History of Psychiatry 18, 459.
3. Albers Evans C, Jones Kenny P & Rizzuto C (1993) Caring for the confused geriatric surgical patient. Geriatric Nursing 14, 237-241.
4. American Psychiatric Association (1999) Practice Guideline for the Treatment of Patients with Delirium. American Psychiatric Association, Arlington, VA.
5. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edn: Text revision (DSM-IV-TR). Available at: (accessed 10 November 2011).
6. American Psychiatric Association (2006) Practice Guideline for the Treatment of Patients with Delirium: Guideline Watch (Update on the 1999 Guideline). American Psychiatric Association, Arlington, VA.
7. Anderson D (2005) Preventing delirium in older people. British Medical Bulletin 73, 25-34.
8. Andersson E, Knutsson I, Hallberg I & Norberg A (1993) The experience of being confused: a case study. Geriatric Nursing 14, 242-247.
9. Andersson E, Hallberg I, Norberg A & Edberg A-K (2002a) The meaning of acute confusional state from the perspective of elderly patients. International Journal of Geriatric Psychiatry 17, 652-663.
10. Andersson E, Norberg A & Hallberg I (2002b) Acute confusional episodes in elderly orthopaedic patients: the patients' actions and speech. International Journal of Nursing Studies 39, 303-317.
11. Australian Society for Geriatric Medicine (2005) Position Statement No. 13: Delirium in Older People. Australian Society for Geriatric Medicine, Sydney.
12. Blazer DG (2008) Treatment of seniors. In The American Psychiatric Publishing Textbook of Psychiatry - Online, 5th edn (Hales RE, Yudofsky SC & Gabbard GO eds). American Psychiatric Publishing, Inc., Arlington, VA, pp. 1449-1470.
13. British Geriatric Society and Royal College of Physicians (2006a) The Diagnosis and Management of Delirium in Older People: Summary Guidelines. Royal College of Physicians, London.
14. British Geriatric Society and Royal College of Physicians (2006b) Guidelines for the Prevention, Diagnosis and Management of Delirium in Older People: Concise Guidance to Good Practice Series, No. 6. British Geriatric Society and Royal College of Physicians, London.
15. Britton AM, Hogan-Doran JJ & Siddiqi N (2006) Multidisciplinary team interventions for the management of delirium in hospitalized patients. Art. No.: CD005995. Cochrane Database of Systematic Reviews, Issue 4, Art. No.: CD005995. Doi
16. Brown T & Boyle M (2002) ABC of psychological medicine: delirium. British Medical Journal 325, 644-647.
17. Budd S & Brown W (1974) Effect of a reorientation technique on post cardiotomy delirium. Nursing Research 23, 341-348.
18. Clinical Epidemiology & Health Service Evaluation Unit (2006) Clinical Practice Guidelines for the Management of Delirium in Older People. AHMAC Department of Health & Ageing, Commonwealth of Australia, Canderra.
19. Cole MG (1994) Systematic intervention for elderly inpatients with delirium: a randomized trial. Canadian Medical Association Journal 151, 965.
20. Cole MG (1999) Delirium: effectiveness of systematic interventions. Dementia and Geriatric Cognitive Disorders 10, 406-411.
21. Cole MG, McCusker J, Bellavance F, Primeau FJ, Bailey RF, Bonnycastle MJ & Laplante J (2002) Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial. Canadian Medical Association Journal 167, 753-759.
22. Crammer JL (2002) Subjective experience of a confusional state. British Journal of Psychiatry 188, 71-75.
23. Duppils GS & Wikblad K (2007) Patients' experiences of being delirious. Journal of Clinical Nursing 16, 810-818.
24. Fagerberg I & Jonhagen ME (2002) Temporary confusion: a fearful experience. Journal of Psychiatric & Mental Health Nursing 9, 339-346.
25. Fann J (2000) The epidemiology of delirium: a review of studies and methodological issues. Seminars in Clinical Neuropsychiatry 5, 64-74.
26. Feil N (1982) V/F Validation: The Feil Method: How to Help Disoriented Old-Old. Edward Feil Productions, Cleveland, OH.
27. Feil N (1993) The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer's Type Dementia. Health Professions Press, Cleveland, OH.
28. Fick DM & Foreman MD (2000) Consequences of not recognising delirium superimposed on dementia in hospitalised elderly individuals. Journal of Gerentonological Nursing 26, 30-40.
29. Fick DM, Agostini JV & Inouye SK (2002) Delirium superimposed on dementia: a systematic review. Journal of the American Geriatrics Society 50, 1723-1732. Doi
30. Flood M & Buckwalter K (2009) Recommendations for mental health care of older adults. Part 2-An overview of dementia, delirium and substance abuse. Journal of Gerontological Nursing 35, 35-47.
31. Foreman M (1986) Acute confusional states in hospitalised elderly: a research dilemma. Nursing Research 35, 34-38.
32. Foreman M, Mion LC, Tryostad L, Fletcher K & Faculty NICHE (1999) Standard of practice protocol: acute confusion/delirium. Geriatric Nursing 20, 147-152.
33. Gillis AJ & MacDonald B (2006) Unmasking delirium: nurses can play a key role in the prevention, detection and treatment of delirium in older adults. Canadian Nurse 102, 19-24.
34. Granberg A, Bergborn Engberg I & Lundberg D (1999) Acute confusion and unreal experiences in intensive care patients in relation to the ICU syndrome. Part II. Intensive and Critical Care Nursing 15, 19-33.
35. Hallberg IR (1999) Impact of delirium on professionals. Dementia and Geriatric Cognitive Disorders 10, 420-425.
36. Hanley C (2004) Delirium in the acute care setting. Medsurg Nursing 13, 217-224.
37. Harding S (2006) Delirium in Older People: An Australian Government Initiative. Australian Department of Health and Ageing, Commonwealth of Australia, Canberra.
38. Holden UP & Woods RT (1982) Reality Orientation: Psychological Approaches to the Confused Elderly. Churchill Livingstone, New York.
39. Holden UP & Woods RT (1988) Reality Orientation: Psychological Approaches to the 'Confused' Elderly, 2nd edn. Churchill Livingston, New York.
40. Holroyd-Leduc JM, Khandwala FM & Sink KMM (2010) How can delirium best be prevented and managed in older patients in hospital? Canadian Medical Association Journal 182, 465.
41. Inouye SK (1994) The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. The American Journal of Medicine 97, 278-288.
42. Inouye SK (1999) Predisposing and precipitating factors for delirium in hospitalized older patients. Dementia and Geriatric Cognitive Disorders 10, 393-400.
43. Inouye SK & Ferrucci L (2006) Elucidating the pathophysiology of delirium and the interrelationship of delirium and dementia. The Journals of Gerontology 61A, 1277-1280.
44. Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR & Cooney L (1999a) A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine 340, 669-676.
45. Inouye SK, Schelesinger MJ & Lydon TJ (1999b) Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. American Journal of Medicine 106, 565-573.
46. Laitinen H (1996) Patients' experience of confusion in the intensive care unit following cardiac surgery. Intensive & Critical Care Nursing 12, 79-83.
47. Lindesay J, Rockwood K & MacDonald A (eds) (2002) Delirium in Old Age. Oxford University Press, New York.
48. Lipowski ZJ (1983) Transient cognitive disorders (delirium, acute confusional states) in the elderly. American Journal of Psychiatry 140, 1426-1436.
49. Lipowski ZJ (1990) Delirium: Acute Confusional States. Oxford University Press, New York.
50. Lundstrom M, Edlund A, Karlsson S, Brannstrom B, Bucht G & Gustafson Y (2005) A multifactorial intervention program reduces the duration of delirium, length of hospitalisation and mortality in delirious patients. Journal of the American Geriatrics Society 53, 622-628.
51. McCurren C & Cronin SN (2003) Delirium: elders tell their stories and guide nursing practice. MEDSURG Nursing 12, 318-323.
52. Meagher DJ (2001) Delirium: optimising management. BMJ 322, 144-149.
53. Meredith RE (1998) Detecting delirium in hospitalised older people. Professional Nurse 13, 760-763.
54. Michaud L, Bula C, Berney A, Camus V, Voellinger R, Steiefel F, Burnand B & The Delirium Guidelines Development Group (2007) Delirium: guidelines for general hospitals. Journal of Psychosomatic Research 62, 371-383.
55. Milisen K, Foreman MD, Abraham IL, De Geest S, Godderis J, Vandermeulen E, Fischler B, Delooz HH, Spiessens B & Broos P (2001) A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. Journal of the American Geriatrics Society 49, 523-532.
56. Milisen K, Lemiengre J, Braes T & Foreman MD (2005) Multicomponent intervention strategies for managing delirium in hospitalized older people: systematic review. Journal of Advanced Nursing 52, 79-90.
57. Minnick A, Leipzig RM & Johnson ME (2001) Elderly patients reports of physical restraint expereinces in intensive care units. American Journal of Critical Care 10, 168-171.
58. Neal M & Barton Wright P (2003) Validation therapy for dementia. Cochrane Database of Systematic Reviews, Issue 3, Art. No.: CD001394. Doi
59. Neville S (2006) Delirium and older people: repositioning nursing care. International Journal of Older People Nursing 1, 113-120.
60. O'Connell B, Gradner A, Takase M, Hawkins M, Ostaszkiewicz J, Ski C & Josipovic P (2007) Clinical usefulness and feasibility of using reality orientation with patients who have dementia in acute care settings. International Journal of Nursing Practice 13, 182-192.
61. Patton D (2006a) Reality orientation: its use and effectiveness within older person mental health care. Journal of Clinical Nursing 15, 1440-1449.
62. Patton D (2006b) The value of reality orientation with older adults who are mentally ill. Journal of Gerontological Nursing 32, 6-13.
63. Pitkala KH, Laurila JV, Strandberg TE & Tilvis RS (2006) Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial. Journals of Gerontology Series A, Biological Sciences and Medical Sciences 61, 176-181.
64. Rapp CG (2001) Acute confusion/delirium protocol. Journal of Gerontological Nursing 27, 21-33.
65. Rizzo JA, Bogardus ST Jr, Leo-Summers L, Williams CS, Acampora D & Inouye SK (2001) Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value? Medical Care 39, 740-752.
66. Robertsson B (2002) The instrumentation of delirium. In Delirium in Old Age (Lindesay J, Rockwood K & MacDonald A eds). Oxford University Press, New York, pp. 9-25.
67. Roche V (2003) Etiology and management of delirium. American Journal Medical Science 325, 20-30.
68. Rockwood KJ (2004) Delirium and frailty. Primary Psychiatry 11, 36.
69. Rockwood K & Lindesay J (2002) The concept of delirium: historical antecedents and present meanings. In Delirium in Old Age (Lindesay J, Rockwood K & MacDonald A eds). Oxford University Press, New York, pp. 2-8.
70. Rockwood KJ, Cosway S, Carver D, Jarrett P & Stadnyk K (1999) The risk of dementia and death after delirium. Age and Ageing 28, 551-556.
71. Rosen S (1994) Managing delirious older adults in the hospital. MEDSURG Nursing 3, 181-189.
72. Schofield I (1997) A small exploratory study of the reaction of older people to an episode of delirium. Journal of Advanced Nursing 25, 942-952.
73. Sendelbach S, Guthrie P & Schoenfelder D (2009) Evidence-based guideline: acute confusion/delirium: identification, assessment, treatment and prevention. Journal of Gerontological Nursing 35, 11-18.
74. Siddiqi N, House AO & Holmes JD (2006) Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age and Ageing 35, 350-365.
75. Ski C & O'Connell B (2006) Mismanagement of delirium places patients at risk. The Australian Journal of Advanced Nursing 23, 42-46.
76. Spector A, Davies S, Woods B & Orrell M (2000) Reality orientation for dementia: a systematic review of the evidence of effectiveness from randomized controlled trials. The Gerontologist 40, 206.
77. Stenwall E, Jönhagen M, Sandberg J & Fagerberg I (2008) The older patient's experience of encountering professional carers and close relatives during an acute confusional state: an interview study. International Journal of Nursing Studies 45, 1577-1585.
78. Tullmann DF, Mion L, Fletcher K & Foreman MD (eds) (2008a) Delirium Prevention, Early Recognition and Treatment, 3rd edn. Springer Publishing, New York.
79. Tullmann DF, Mion LC, Fletcher K & Foreman MD (2008b) Nursing Standard of Practice Protocol: Delirium: Prevention, Early Recognition and Treatment. Available at: (accessed 4 December 2009).
80. Williams MA, Holloway JR, Winn MC, Wolanin MO, Lawler ML, Westwick CR & Chin M (1979) Nursing activities and acute confusional states in elderly hip-fractured patients. Nursing Research 28, 25-35.
81. Young J, Leentjens AF, George J, Olofsson B & Gustafson Y (2008) Systematic approaches to the prevention and management of patients with delirium. Journal of Psychosomatic Research 65, 267-272.