Table J7Risk factors targeted in the Inouye study (1999), the materials used and instructions in the intervention group of the study, and the anticipated NHS resources required to apply the intervention protocol to NHS patients

Targeted Risk FactorsMaterials and instructionsWhich extra NHS resources?Which NHS resources are assumed to be available?
1. Cognitive Impairment
  1. Board, pens
  2. Time resources for reorientation related communication
a. Orientation protocolBoard with names of care-team members and day’s schedule; communication to re-orientate to surroundings 3 × daily
  1. Standard word game
b. Therapeutic-activities protocolCognitively stimulating activities 3 × daily (e.g. discussion of current events, structured reminiscence, or word game)
2. Sleep Deprivation
  1. Warm drink
  2. Resources for back massage
  3. We did not account for unit-wide noise-reduction strategies
  4. Time resources for adjustments to allow sleep
a. Non-pharmacological sleep protocolAt bedtime, warm drink (milk or herbal tea), relaxation tapes or music, and back massage, once daily
  1. Relaxation tapes or music
b. Sleep enhancement protocolUnit-wide noise-reduction strategies (e.g. silent pill crushers, vibrating beepers, and quite hallways) & schedule adjustments to allow sleep (e.g. rescheduling of medications and procedures), once daily
3. Immobility
Early mobilization protocolAmbulation or active range of motion exercises 3 times daily. Minimising use of immobilising equipment (e.g. Bladder catheters, physical restraint)
  1. Time resources for mobility enhancement resources
4. Visual Impairment
  1. Large print books are already available
  2. Time resources for daily reinforcement
Vision protocolVisual aids (e.g. glasses or magnifying lenses) and adaptive equipment (e.g. large illuminated telephone key pads, large prints books, fluorescent tape on call bell), with daily reinforcement of their use
5. Hearing Impairment
  1. Time resources for earwax disimpaction, special communication techniques and daily reinforcement
Hearing protocolPortable amplifying devices, earwax disimpaction & special communication techniques, with daily reinforcement of these adaptations
6. Dehydration
  1. Dehydration prevention protocol is included in usual care
Dehydration protocolEarly recognition and volume repletion (e.g. encouragement of oral fluid intake)

From: Appendix J, Health economics appendix

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Delirium: Diagnosis, Prevention and Management [Internet].
NICE Clinical Guidelines, No. 103.
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