Primary prevention of delirium

Delirium is the most important neuro-psychiatric problem among elderly admitted to general hospitals. With an average incidence above 25% and increasing to almost 90% in the ICUpopulation. It is a serious andpotentiallypreventablemental condition. It is therefore important to recognise patients at risk for delirium on admittance to the hospital, so primary preventive programs can be started. Manyof the risk factors arewell-known,bothpredisposingandprecipitating factors. Some of these risk factors have been combined to make predictive models for delirium. Much further work is needed to determine and examine specific risk factors and their value in models for the prediction of delirium in different patient groups. Based on recent knowledge on predisposing and precipitating risk factors for delirium, interventions have been proposed to influence the detrimental effects of these factors and thus prevent (primary prevention) or to reduce its duration and severity (secondary prevention). Relatively few interventions have been evaluated and supported by good quality clinical trials. Some of the trials support multicomponent intervention strategies consisting of nursing, medical and sometimes pharmacological components. In this symposium we will provide the latest data on riskassessment, targeting patients at risk and existing models for prevention of delirium. We will show the work we did on the development of a very simple and highly effective Delirium Risk Assessment Score model (DRAS) and show the data on its use in different patient groups (surgical, cardiology and stroke) and the positive effect of a multicomponent intervention program, after identifying risk patients, on incidence, duration and severity of delirium.