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Hypoactive Delirium Management — RACP Adult Medicine MCQ

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ModerateNeurologyHypoactive Delirium ManagementRACP Adult Medicine

A 75-year-old woman with no prior cognitive impairment develops hypoactive delirium (withdrawn, drowsy, inattentive) during a hospital admission for pneumonia. 4AT score is 8. Her medications include cefalexin, regular paracetamol, and melatonin. Bloods are unremarkable except CRP 85. What is the most important management strategy?

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Correct answer: C — Non-pharmacological multicomponent intervention

Hypoactive delirium (most common, often missed) is best managed with non-pharmacological multicomponent interventions: treat underlying cause (pneumonia), orientation aids (clock, calendar, familiar objects), sleep hygiene, early mobilisation, adequate hydration/nutrition, avoid unnecessary catheterisation, minimise room changes, and family involvement. Antipsychotics and benzodiazepines should be avoided for hypoactive delirium.

Reference: ACSQHC – 2024 – Delirium Clinical Care Standard; NICE 2024