It is recognised from research in the aged care population that environmental aspects of hospitals contribute to delirium, and environmental alterations can prevent delirium. 
A number of studies in aged care settings use multicomponent interventions to attempt to prevent delirium in patients at high risk. Provision of specialist geriatric medical / nursing interventions have been studied. Environmental interventions have focused on normalising sleep patterns, regular activities to maintain cognitive stimulation, limiting the use of catheters and restraints, encouraging mobilisation, regularly reorienting patients, maintaining hydration, and providing and using vision and hearing aids. These interventions involve changes in the organisation of care, and institutionalising these changes is a significant challenge. [1,2]
Questions about how settings of care affect the mental state of cognitively vulnerable palliative care patients, which aspects of the organisation of care may contribute to the incidence of delirium in palliative care patients, and how delirium impacts on a patients’ ability to be cared for in different settings (including at home) are being studied.
A systematic review demonstrated that a multicomponent non-pharmacological approach to patient care reduced the incidence of delirium in hospitalised older people.  This research did not specially look at patients receiving palliative care. A study involving palliative care patients examined the use of multicomponent non-pharmacological interventions to reduce the incidence and severity of delirium.  The study examined the effects of orientation techniques, cognitive stimulation on patients as well supportive advice for family members and information for staff. The authors were unable to establish a clear benefit to these approaches but given the low risk, cost and acceptability of these techniques a recent systematic review recommends their implementation. 
Last updated 27 August 2021