Confusional states: The 4Ds: Delirium, Dementia, Depression & Dignity- January 2013


Confusional states 4Ds: Delirium, Dementia, Depression & Dignity


Listed below is the high level evidence on Confusional states 4Ds: Delirium, Dementia, Depression & Dignity produced by NICE, SIGN and NHS based organisations. Also included are the European Society guidelines where available. This list is produced and maintained by HEFT Library Services to support VITAL 4 Medics core skills programme developed in the Trust.


HEFT Local Policies

Acute confusional state confusion elderly sedation geriatric delirium assessment

Dr P Wallis, HEFT 01/03/2006. Next review date?


Map of Medicine


Delirium (acute confusional state)


Dementia – assessment


Depression - severe and complex


Depression - moderate to severe


Depression - mild to moderate



End of life care in adults - care in the last days of life


National Guidelines & Non-UK Guidelines (includes Professional Bodies/Associations)




Delirium: Evidence Update April 2012

A summary of selected new evidence relevant to NICE CG103 ‘Delirium: diagnosis, prevention and management’ (2010)


Delirium: diagnosis, prevention and management

NICE Clinical Guideline CG103 July 2010


Intervention Protocol

Annette M Britton, Jonathon Hogan-Doran, Najma Siddiqi

Multidisciplinary Team Interventions for the management of delirium in hospitalized patients


Interventional Review

Annette M Britton, Robert Russell

Multidisciplinary team interventions for delirium in patients with chronic cognitive impairment




CG42 Dementia: Supporting people with dementia and their carers in health

and social care


CG42 Dementia: audit support (update) 03 April 2009


Dementia Pathway




CG90 Depression in adults: The treatment and management of depression in



Depression Pathway




Empathy, dignity and respect


Systematic Reviews – Cochrane Library




Interventions for preventing delirium in hospitalised patients

Jackson KC, Lipman, AG

Drug therapy for delirium in terminally ill adult patients: October 2009




Sydenham E, Dangour AD, Lim WS

Omega 3 fatty acid for the prevention of cognitive decline and dementia (Review) 13 June 2012




Intervention Review

      Maree L Hackett, Craig S Anderson, Allan House, Jun Xia

Interventions for treating depression after stroke




Chochinov HM, Kristjanson LJ, Breitbart W, McClement S, Hack TF, Hassard T, Harlos M
Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial.
Lancet Oncol. 2011 Aug;12(8):753-62. Epub 2011 Jul 6.


NHS Evidence


Confusional States


Lorenzl S, Füsgen I, Noachtar S.

Acute confusional states in the elderly-diagnosis and treatment.

Deutsches  Arzteblatt Int.ernational 2012 May;109(21):p 391-400.

Epub 2012 May 25


Insel KC, Badger TA.

Deciphering the 4 D's: cognitive decline, delirium, depression and dementia—a review. 

Journal of Advanced Nursing:  2002; 38(4): p 360-368.


Andersson EM, Hallberg IR, Norberg A, Edberg AK.

The meaning of acute confusional state from the perspective of elderly patients.

International Journal of Geriatric Psychiatry. 2002 Jul;17(7) p 652-63.


Gustafson, Yngve; Brännström, Benny; Berggren, Diana; Ragnarsson, Jón I

A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures.

Journal of the American Geriatrics Society, Jul 1991, Vol 39(7) p  655-662.


Gustafson Y, Brännström B, Norberg A, Bucht G, Winblad B.

Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients.

Journal of American Geriatric Society: 1991, August 39(8) p 760-5


Gustafson, Y.; Berggren, D.; Brännström, B.; Bucht, G

Acute confusional states in elderly patients treated for femoral neck fracture.

Journal of the American Geriatrics Society, Vol. 36(6), Jun 1988, 525-530.


William, MA

Predictors of acute confusional states in hospitalized elderly patients

Research in Nursing & Health, March 1985, Vol 8,(1) pages 31–40, 


S Saeed, O Farooqi, B Panayiotou, and T Harvey

Reversible confusional state in an elderly man

Postrgaduate Medical Journal, 75(884) p 365-367




Holroyd-Leduc JM, Khandwala F, Sink KM

How can delirium best be prevented and managed in older patients in hospital?

CMAJ. 2010 Mar 23; 182(5) p 465-70. Epub 2009 Aug 17.




Fischer, C E; Schweizer, T A; Joy, J

Determining the impact of dementia on antidepressant treatment response in older adults.

The Journal of Neuropsychiatry and Clinical Neurosciences, 2011, vol. 23(3)

 p 358-361




Ciro, CA; Ottenbacher, KJ; Graham, JE

Patterns and correlates of depression in hospitalized older adults.

Archives of Gerontology and Geriatrics, January 2012, Vol. 54(1) 202-205


Lapid, Maria I; Piderman, Katherine M

Improvement of quality of life in hospitalized depressed elderly.

International Psychogeriatrics, April 2011, Vol. 23(3) p 485-495


Han, L; McCusker, J; Cole, M

Antidepressant use and cognitive functioning in older medical patients with major or minor depression: A prospective cohort study with database linkage.

Journal of Clinical Psychopharmacology, August 2011, vol. 31(4) 429-435





Wood, Julia

Review of Dignity in care for older people.

Nursing Ethics, May 2011, Vol.18(3) p 459


Webster, C; Bryan, K

Older people's views of dignity and how it can be promoted in a hospital environment.

Journal of Clinical Nursing, June 2009, vol. 18(12) p 1784-1792


Webster, C; Bryan, K

Older people's views of dignity and how it can be promoted in a hospital environment.

Journal of Clinical Nursing, June 2009, vol. 18(12) p 1784-1792