Delirium Program

The Mount Sinai Health System has a unique program to identify and treat delirium ꟷ a sudden severe decline in mental health characterized by confusion and caused by a medical condition. Working throughout the health system, our core team of multidisciplinary medical providers has extensive training in diagnosing symptoms of delirium in hospitalized patients and providing appropriate treatments. We access real-time patient clinical information through Mount Sinai’s electronic medical records system to pinpoint patients at risk. We expand our outreach by educating hospital staff and patient families to help us identify patients with symptoms of delirium and support their treatment.

About Us

The goal of our delirium program is to identify cases of delirium in order to minimize the length of hospital stays, improve recovery from acute medical conditions and surgery, raise survival rates and limit hospital readmission, and allow patients to return to their homes and resume their lives.

Services We Offer  

Mount Sinai's delirium program leverages technologies and approaches that allow us to identify and treat patients with delirium, through the following services:

  • All appropriately identified patients receive screening for the presence of delirium or the near onset of delirium (subsyndromal delirium). We use the confusion assessment method (CAM) in regular hospital patients and those in the intensive care unit (CAM-ICU).
  • Epic, Mount Sinai's electronic medical records system, enables us to:
    • Alert providers and nursing staff of the presence of a delirium or subsyndromal delirium diagnosis in their patients utilizing an automated alert system
    • Automate the use of CAM and CAM-ICU data to diagnose patients with delirium and subsyndromal delirium
    • Use initial findings and recommendations by our team help other health care providers care for their delirious patients
    • Automatically populate charts with nursing care plans for delirium for patients identified as delirious and subsyndromally delirious
  • Sensory support through hearing aids and magnifiers are provided to delirious patients following the assessment of visual and auditory acuity 

Risk Factors for Delirium

While delirium can occur at any age, the geriatric population is particularly prone to delirium and its complications. Post-operative older adults are at special risk for developing delirium. Complications of hospitalization in approximately 20 percent of patients over 65 years old in the United States are due to delirium. Many of these cases go undiagnosed.

Typically, delirium is caused by some other medical illness, such as pneumonia or following surgery along with one or more of the following risk factors:

  • Being bedbound or immobile
  • Dehydration
  • Lack of stimulation, such as no access to the following:
    • Calendar or clock to orient to time
    • Familiar objects around to see
    • Interaction with other people
  • Loss of senses, such as hearing or visual problems
  • Malnourishment
  • Old age - 70 years and above
  • Taking certain medications

Symptoms of Delirium

The symptoms of delirium can vary. Any combination of cognitive and behavioral changes can be present, including:

  • Changes in every day behavior such as:
    • Sleeping too much
    • Not answering questions
    • Not moving much
    • Not eating
  • Conversations that make no sense or speech that cannot be understood
  • Hallucinations, such as seeing imaginary people or animals
  • Illusions, such as thinking a coat on a chair is a person
  • Not knowing the day, month, year, or where they are
  • Not remembering why they are in the hospital, that you came to visit the previous day, or information you told them a few minutes ago
  • Picking at clothing, trying to get out of bed without assistance, pulling out IVs, taking off clothes, yelling, trying to hit people
  • Reduced awareness of the person’s surroundings and problems with attention, such as asking the same questions over, or giving the same answer over and over even though you are asking a different question, or the person may not be able to talk with you at all)
  • Sleeplessness at night and sleepiness during the day 

Diagnosing Delirium

Delirium is diagnosed based on the cognitive and behavioral symptoms associated with this syndrome. These disturbances are not better explained by a pre-existing, established, or evolving neurocognitive disorder. There is evidence that these disturbances are a direct physiological consequence of another medical condition, substance intoxication or withdrawal or exposure to a toxin.

Treatments We Offer 

Mount Sinai delirium program addresses the full range of patient needs by:

  • Ensuring proper hydration and nutrition
  • Helping the delirious person become active as quickly as possible, according to an assessment of their abilities by getting them out of bed and in a chair or walking with the assistance of physical therapy
  • Identifying and treating quickly the underlying medical and/or surgical problems that are causing the delirium
  • Lowering the dosage of or stop those medications which can be associated with the delirium
  • Providing medication only when necessary to treat dangerous behaviors (such as pulling out IV lines, hitting staff and family) and to treat hallucinations
  • Reminding them of the date, time, place, who their hospital caregivers are, why they are in the hospital, what medications they are receiving and why. Update the orientation board in their room daily
  • Removing tubing, such as urinary catheters as soon as possible 

How You Can Help With the Delirium Treatment

  • Make sure you, other family, friends, and caregivers visit the delirious patient as often as possible
  • Bring things to the hospital to help with orientation (such as clock, calendar)
  • Talk to the delirious patient, work on puzzle books, read, play games

Meet Our Team

The Mount Sinai multidisciplinary team uses innovative technologies that provide smart decision support to our team headed up by: