Orientation strategies during delirium: are they helpful?

Aim: This paper critiques literature that reports older person experiences of orientation strategies in relation to current recommendations for the management of older person delirium and makes recommendations for future research. Background: Delirium is a common syndrome in hospitalised older people and a difficult syndrome for health care staff to manage. During delirium, older people describe experiencing altered states of reality and use of orientation strategies as part of their care. Orientation, a non-pharmacological approach to the management of delirium, is recommended as a care strategy in evidence-based guidelines and protocols. Method: Discursive paper. Discussion: This paper considers published research into the experiences of hospitalised older people during an episode of delirium and questions the appropriateness of orientation strategies. How care strategies are experienced by older people is emphasised. An approach to care which is a flexible balance of reality orientation and validation therapy, synchronised with the changing reality and reactions of the older person, is identified as a care recommendation from research. Conclusion: When delirium is experienced during hospitalisation, health care staff have a responsibility to provide care that is person-centred and sensitive to the older person’s needs. It has been assumed that no harm comes from the use of orientation approaches, and delirium management guidelines have recommended this approach. However, orientation strategies can lead to mistrust of, and distancing from, health care staff and family, so impeding their relationships with carers. Care practices that consider the older person to be unique and that synchronise with the older person’s changing experiences of reality are suggested for further research. Relevance to clinical practice: Caring for an older person in delirium is challenging for health care staff. Reconsideration of, and research into, care strategies during delirium has the potential to improve the quality of care for hospitalised older people