Delirium threatens the functional independence and cognitive capacity of patients. Medications, especially those with strong anticholinergic effects, have been implicated as a preventable cause of delirium. We evaluated the effect of multicomponent interventions aimed at reducing the use of 9 target medications in hospitalized older adults at risk of delirium. This continuous quality improvement program was undertaken at a tertiary care facility and 4 community hospitals in a hospital system. We included 21, 541 hospital admissions with patients aged 70 and older on acute care medical or surgical units from the preintervention (2012) period, and 27,764 from the postintervention (2015) period. Implemented interventions include formulary and policy changes, technology-assisted medication review, age-conditional order set modifications, best practice alerts, and education. The proportion of hospital admissions with individual's receiving at least 1 target medication declined from 45.6% to 31.3% (relative reduction (RR)=31.4%) from before to after the intervention, meaning that target medication exposure was avoided in approximately 4,000 older adults. The greatest effect was observed for zolpidem (11.2% to 5.3%, RR=52.6%) and diphenhydramine (12.9% to 7.1%, RR=45%). Furthermore, the mean number of doses administered during all hospital admissions was reduced for 7 of 9 medications. Multicomponent interventions implemented in our hospital system were effective at reducing exposure to target medications in hospitalized older adults at risk of delirium. These systematic changes applied throughout the medication use process are sustained today.

Delirium is a leading cause of preventable injury in hospitalized patients. Early recognition and intervention for delirium are critical to prevent morbidity and mortality, especially in the older population. Older patients are at increased risk for delirium owing to a combination of age-related changes and environmental factors. Health care providers, including nurses and physicians, often miss delirium symptoms and diagnosis in patients. Without early recognition and treatment, delirium can have significant life-changing consequences in our most vulnerable patients. This acute change in cognition can continue throughout the hospital course and may require additional rehabilitation or placement, delaying transition to home. As the baby boomers age, the older population is expected to increase, with significant implications for health care. With this in mind, the health care team, including frontline caregivers, need to be well informed about delirium. This article will expand readers' knowledge and familiarity with delirium with the purpose of improving their practice and care of the older patient. It will also address the impact of delirium and discuss tools that can help to improve recognition. The most recent advances and current treatment methods to integrate into daily patient care are also discussed. This article places heavy emphasis on identification and prevention of delirium as these are the most important aspect of understanding delirium. Thus, treatment and management are both discussed after prevention since the primary focus of delirium is understanding and preventing this devastating syndrome in our hospitalized patients.

Cognitive impairment could substantially impair a patient's ability to comprehend education provided during hospitalization. Pharmacy students can feasibly perform Mini-Cog™ assessments to evaluate cognitive function, thereby allowing them to tailor education content and involve caregivers when necessary.