Open Access Open Access  Restricted Access Subscription or Fee Access

The recreational therapist’s role in treating delirium

Suzanne Fitzsimmons, MS, GNP, ARNP, Linda L. Buettner, PhD, CTRS, LRT


Delirium is a common syndrome in older adults especially for those in hospital and acute settings. Delirium is sometimes reversible; however, it is associated with increased mortality, increased hospital costs, and long-term cognitive and functional impairment. Fortunately if recognized early, it can be treated successfully without complications and declines in health and function. Delirium can also be prevented with identification of highrisk patients and the implementation of interventions. Because delirium may be underrecognized by physicians and nurses, routine screening for delirium should be part of comprehensive nursing care of older adults. Recognition of delirium is complicated as it may be difficult to differentiate delirium from dementia and depression. This article will review the risks, signs and symptoms, consequences, and assessment techniques for the detection of delirium in this population.


delirium, recreational therapy, screening

Full Text:



Huth E: Hippocrates. The book of prognostics. In Adams F (ed.): The Genuine Works of Hippocrates. London: C and J Adlard Printers, 1849; Reprinted in Birmingham, AL: Classics of Medicine Library, 1985: 238.

Wolff HG, Curran D: Nature of delirium and allied states: The dysergastic reaction. Arch Neurol Psychiatry. 1935; 51: 378-392.

Engle G, Romano J: Studies of delirium II. Reversibility of the encephalogram with experimental procedure. Arch Neurol Psychiatry. 1944; 55: 378-392.

Engle G, Romano J: Delirium, a syndrome of cerebral insufficiency. J Chronic Dis. 1959; 5: 260-277.

Inouye S: Delirium in Older Persons. N Engl J Med. 2006; 354: 1157-1116.

Miller RR, Ely EW: Delirium and cognitive dysfunction in the intensive care unit. Semin Respir Crit Care Med. 2006; 27(3): 210-220.

Fick DM, Agostini JV, Inouye SK: Delirium superimposed on dementia: a systematic review. J Am Geriatr Soc. 2002; 50(10): 1723-1732.

Simon SE, Bergmann MA, Jones RN, et al.: Reliability of a structured assessment for nonclinicians to detect delirium among new admissions to postacute care. J Am Med Dir Assoc. 2006; 7(7): 412-415.

Peterson JF, et al.: Delirium and it motoric subtypes: A study of 614 critically ill patients. J Am Geriatr Soc. 2006; 54(3): 479-484.

Dahlke S, Phinney A: Caring for hospitalized older adults at risk for delirium: The silent, unspoken piece of nursing practice. J Gerontol Nurs. 2008; 34(6): 41-47.

Voyer P, Richard S, Doucet L, et al.: Detection of delirium by nurses among long-term care residents with dementia. BMC Nurs. 2008; 7: 4.

Korevaar JC, van Munster BC, de Rooij SE: Risk factors for delirium in acutely admitted elderly patients: A prospective cohort study. BMC Geriatr. 2005; 5: 6.

Fick D, Mion L: Assessing and Managing Delirium in Older Adults with Dementia. Try This Series. John A. Hartford Institute for geriatric nursing. Available at Accessed July 25, 2008.

McAlpine JN, Hodgson EJ, Abramowitz S, et al.: The incidence and risk factors associated with postoperative delirium in geriatric patients undergoing surgery for suspected gynecologic malignancies. Gynecol Oncol. 2008; 109(2): 296-302.

Bellelli G, Morghen S, Turco R, et al.: Delirium in older people: An epiphenomenon of incipient death or a separate biological process? Age Ageing. 2007; 37(3): 353-354.

Huang: Delirium. Merck Manual. Available at Accessed July 25, 2008.

Gaudreau JD, Gagnon P, Harel F, et al.: Psychoactive medications and risk of delirium in hospitalized cancer patients. J Clin Onocol. 2005; 23(27): 6712-6718.

Culp KR, Cacchione PZ: Nutritional status and delirium in long-term care elderly individuals. Appl Nurs Res. 2008; 21(2): 66-74.

Yang FM, Inouye SK, Fearing MA, et al.: Participation in Activity and Risk for Incident Delirium. J Am Geriatr Soc. 2008; 56(8): 1479-1484.

Cremer OL, Kalkman CJ: Cerebral pathophysiology and clinical neurology of hyperthermia in humans. Progr Brain Res. 2007; 162: 153-169.

Kat MG, Vreeswijk R, de Jonghe JF, et al.: Long-term cognitive outcome of delirium in elderly hip surgery patients. A prospective matched controlled study over two and a half years. Dement Geriatr Cogn Disord. 2008; 26(1): 1-8.

Bruce AJ, Ritchie CW, Blizard R, et al.: The incidence of delirium associated with orthopedic surgery: A meta-analytic review. Int Psychogeriatr. 2007; 19(2): 197-214.

Krichbaum JA: American Burn Association. Letter to Department of Health and Human Services: Centres for Medicare and Medicaid Service. Available at Accessed July 25, 2008.

Robinson S, Vollmer C, Jirka H, et al.: Aging and delirium: Too much or too little pain medication? Pain Manag Nurs. 2008; 9(2): 66-72.

Adamis D, Treloar A, Darwiche F, et al.: Associations of delirium with in-hospital and in 6-months mortality in elderly medical inpatients. Available at Accessed July 25, 2008.

Miranda M, Slachevsky A, Venegas P: Delirium from nicotine withdrawal in a post-operative adult patient. Revista médica de Chile. 2005; 133(3): 385-386.

Agar M, Lawlor P: Delirium in cancer patients: A focus on treatment-induced psychopathology. Curr Opin Oncol. 2008; 20(4): 360-366.

Kalisvaart KJ, Vreeswijk R, de Jonghe JF, et al.: Risk factors and prediction of postoperative delirium in elderly hipsurgery patients: Implementation and validation of a medical risk factor model. J Am Geriatr. 2006; 54(5): 817-822.

Echigoya Y, Kato H: Causes of postoperative delirium after abdominal surgery in elderly patients. Masui. 2007; 56(8): 932-936.

Girard TD, Pandharipande PP, Ely EW: Delirium in the intensive care unit. Crit Care. 2008; 12 (Suppl 3): S3.

Yudofsky SC, Hales RE: The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences, 5th ed. Arlington, VA: American Psychiatric Publishing, 2008.

Ranhoff AH, Rozzini R, Sabatini T, et al.: Delirium in a sub-intensive care unit for the elderly: Occurrence and risk factors. Aging Clin Exp Res. 2006; 18(5): 440-445.

Voyer P, McCusker J, Cole MG, et al.: Factors associated with delirium severity among older patients. J Clin Nurs. 2007; 16(5): 819-831.

Holden J, Jayathissa S, Young G: Delirium among elderly general medical patients in a New Zealand hospital. Intern Med J. 2008; 38(8): 629-634

Ferrario CG: Geropharmacology: A primer for advanced practice. Acute care and critical care nurses, part II. AACN. Adv Crit Care. 2008; 19(2): 134-149.

Cerullo MA: Expect psychiatric side effects from corticosteroid use in the elderly. Geriatrics. 2008; 63(1): 15-18.

Fick D, Mion L: How to try this: Delirium superimposed on dementia. Am J Nurs. 2008; 108(1): 52-60.

Britton A, Russell R: Multidisciplinary team interventions for delirium in patients with chronic cognitive impairment. Cochrane Database Syst Rev. 2007; 18(2): CD000395.

Kolanowski A, Piven AL: Geropsychiatric nursing: The state of the Science. J Am Psychiatr Nurs Assoc. 2006; 12(2): 91-99.

Gillis AJ, MacDonald B: Unmasking delirium. Canadian Nurse. 2006; 102(9): 18-24.

Inouye SK, Bogardus ST Jr, Baker DI, et al.: The hospital elder life program: A model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital elder life program. J Am Geriatr Soc. 2000; 48(12): 1697–1706.

Waszynski CM: How to try this: Detecting delirium. Am J Nurs. 2007; 107(12): 50-59.

Edlund A, Lundström M, Sandberg O, et al.: Symptom profile of delirium in older people with and without dementia. J Geriatr Psychiatry Neurol. 2007; 20(3): 166-171.

Marcantonio ER, Kiely DK, Simon SE, et al.: Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc. 2006; 53(6): 963-969.

Kiely DK, Jones RN, Bergmann MA, et al.: Association between delirium resolution and functional recovery among newly admitted postacute facility patients. J Gerontol Biol Sci Med Sci. 2006; 61(2): 204-208.

Fick D, Kolanowski A, Waller J: High prevalence of central nervous system medications in community-dwelling older adults with dementia over a three-year period. Aging Mental Health. 2007; 1(5): 588-595.

Loponen P, Luther M, Wistbacka J, et al.: Postoperative delirium and health related quality of life after coronary artery bypass grafting. Scand Cardiovasc J. 2008; 42(2): 1401-7431.

Caplan G: Does ‘hospital in the home’ treatment prevent delirium? Aging Health. 2008; 4(1): 69-74.

Lin MH, Wu PY, Chen TJ, et al.: Analysis of long-stay patients in the hospice palliative ward of a medical center. J Chin Med Assoc. 2008; 71(6): 294-9.

de Saint-Hubert M, Swine C: Evolving definitions of frailty. Aging Health. 2007; 3(5): 589-593.

Leslie DL, Marcantonio ER, Zhang Y, et al.: One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008; 168(1): 27-32.

Evans LK, Cotter VT: Avoiding restraints in patients with dementia. Am J Nurs. 2008; 108(3): 41-49.

US Department of Health and Human Services Centers for Medicare & Medicaid Services (DHHS): Nursing home: Resident rights. Available at ResidentRights.asp. Accessed March 23, 2007.

FDA: A guide to bed safety bed rails in hospitals, nursing homes and home health care: The facts. US Food & Drug Administration. Available at Accessed July 29, 2008.



  • There are currently no refbacks.