Progress of nursing management for delirium in critically ill geriatric patients: a narrative review

Abstract

Delirium is the most common and modifiable acute cognitive complication in elderly critically ill patients and is associated with prolonged hospital stays, increased mortality, persistent long-term cognitive decline, and a significant healthcare burden. A history of mild cognitive impairment or dementia further increases delirium risk, exacerbates symptom severity, and worsens clinical outcomes. Nonpharmacological nursing interventions form the cornerstone of delirium prevention and management. However, nurse-centered integrated comprehensive care pathways remain insufficiently integrated. This narrative review systematically synthesizes peer-reviewed evidence retrieved from the PubMed, Web of Science, and Scopus databases up to July 2025, focusing on the nursing management of delirium in elderly critically ill patients. The content encompasses modifiable risk factors, validated bedside assessment scales (including CAM-ICU, ICDSC, 4AT, and home-based tools such as FAM-CAM and IQCODE), and evidence-based multicomponent nonpharmacological intervention strategies. The core intervention domains include the Hospital Elder Life Program (HELP), the eCASH care model, medication safety monitoring, early mobilization, sleep optimization, reduction in physical restraints, orientation training, behavioral symptom management, and postdischarge home safety guidance. Additionally, this review evaluates the current status, clinical value, and limitations of emerging digital technologies applied to delirium care, including wearable monitoring devices, virtual reality-assisted cognitive rehabilitation, and artificial intelligence-augmented clinical decision support systems. This review aims to provide a theoretical foundation and practical reference for frontline nurses implementing evidence-based delirium management in elderly critically ill patients.