The American Geriatrics Society released some new guidelines regarding the prevention and treatment of post-operative delirium in older adults. Delirium is often cited as a justification for using psychotropic drugs. The guidelines essentially state that patients with delirium or at risk of delirium should be made as healthy and comfortable as possible. Adequate sleep, exercise, nutrition/hydration, pain management, prevention of constipation, and re-orientation are important. Medications that can exacerbate or cause delirium, such as sedatives, anti-anxiety drugs, and some antidepressants, should obviously be avoided. Benzodiazapenes (a type of anti-anxiety drug such as Ativan and Xanax) should never be used as a front-line treatment to delirium. Antipsychotics are not recommended unless there is severe agitation or the patient is a harm to herself or others and even then the drugs should be used cautiously as a last resort.
The guidelines are useful in reinforcing the basic message of good dementia care: a drug-first response to treatment is typically ineffective and often counter-therapeutic. Making people feel comfortable, pain free, and safe is the best route for addressing reasonable agitation and distress.