Preventing delirium and managing cognitive impairment

Action 5.29
The health service organisation providing services to patients who have cognitive impairment or are at risk of developing delirium has a system for caring for patients with cognitive impairment to: Incorporate best-practice strategies for early recognition, prevention, treatment and management of cognitive impairment in the care plan, including the Delirium Clinical Care Standard, where relevant Manage the use of antipsychotics and other psychoactive medicines, in accordance with best practice and legislation.

Action 5.29

The health service organisation providing services to patients who have cognitive impairment or are at risk of developing delirium has a system for caring for patients with cognitive impairment to:

Incorporate best-practice strategies for early recognition, prevention, treatment and management of cognitive impairment in the care plan, including the Delirium Clinical Care Standard, where relevant
Manage the use of antipsychotics and other psychoactive medicines, in accordance with best practice and legislation.

Intent

Strategies for improvement

Incorporate reasonable adjustment for people with intellectual disability

Ensure that clinicians are aware people with intellectual disability are at risk of developing early onset dementia and delirium.

People with intellectual disability in Australia are at a higher risk of developing dementia than the general Australian population. People with Downs Syndrome are at risk of Alzheimer’s disease from about the age of 40, while people with intellectual disability generally are at risk of dementia onset at least 10 years earlier than the general population.^[73]

To address these risks, it is important to incorporate reasonable adjustments when implementing the Delirium Clinical Care Standard. For instance:

Include intellectual disability as a risk factor for delirium
Support clinicians to consider whether dementia or cognitive impairment may have gone undiagnosed for a person with intellectual disability
Where a diagnosis of either dementia or delirium is suspected, make sure clinicians consider:
Using appropriate cognitive impairment screening and carer report interview tools
Referring patients for comprehensive cognitive assessments during the admission if any risk is suspected.⁷³

Resources

University of NSW Department of Developmental Disability Neuropsychiatry (3DN) Dementia in people with Intellectual Disability: Guidelines for Australian GPs
Intellectual Disability Health Education by 3DN e-Learning for carers, health professionals and disability professionals
Dementia and people with learning disabilities: making reasonable adjustments - guidance - GOV.UK (www.gov.uk)
Dementia Australia Intellectual disability and dementia training tools
National Task Group on Intellectual Disabilities and Dementia Practices NTG Early Detection Screen for Dementia
The British Psychological Society Dementia and People with Intellectual Disabilities.