Conduct a delirium risk assessment in the pre-admission clinic or within 24 hours of presentation to hospital for admitted patients. Identify key risk factors that include any of the following:
- Age ≥65 years (≥45 years for Aboriginal and Torres Strait Islander people)
- Known cognitive impairment or diagnosed dementia
- A previous diagnosis of delirium
- A severe medical illness (a clinical condition that is deteriorating or is at risk of deterioration)
- Current hip fracture.
Patients with any of these risk factors should receive a validated screening test for cognitive impairment, which is recognised as a significant risk factor for developing delirium. Conducting cognitive screening on presentation to hospital helps identify patients who should be assessed for delirium and enables monitoring for delirium onset during a hospital stay by providing a baseline measure. This also applies to patients with known cognitive impairment. Offer screening for cognitive impairment using a validated tool that is culturally appropriate. (See ‘Related resources’ tab.)
Assess the risk of delirium before a planned admission, particularly for surgical and procedural interventions. Patients and carers should be advised of their risk and potential consequences of developing delirium, to inform decision-making and consent and to help with management if delirium does develop.
When screening identifies probable cognitive impairment, clinical assessment for delirium is necessary (see Quality statement 4). Note that a positive score on a screening tool is not a diagnosis, but a prompt for further assessment, early intervention and early family involvement.