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

Listed below is the high level evidence on Confusional states 4Ds: Delirium, Dementia, Depression and 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 Doctors core skills programme developed in the Trust.


Local (HEFT) Policies

Acute confusional state confusion elderly sedation geriatric delirium assessment

Dr P Wallis, March 2006. Review date?

Chaperoning Adults Policy and Procedure v2.0

Jo Richmond, Review date: 31/07/2013


NICE (guidelines and pathways)


Diagnosis, prevention and management

CG103: July 2010

Supporting people with dementia and their carers in health and social care

CG42: March 2011

The treatment and management of depression in adults

CG90: April 2009

Delirium pathway

Dementia pathway

Depression pathway

Patient experience in adult NHS services overview


Map of Medicine

Delirium (acute confusional state)


Depression – in adults

Dignity - End of life care in adults



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

Improving care for people with dementia

April 2013


Systematic Reviews – Cochrane Library

Drug therapy for delirium in terminally ill adult patients

Review: November 2012

Interventions for preventing delirium in hospitalised patients

Review: January 2009

Omega 3 fatty acid for the prevention of cognitive decline and dementia

Review: June 2012

Functional analysis-based interventions for challenging behaviour in dementia

Review: February 2012

Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression

Review: December 2012

Information provision for stroke patients and their caregivers

Review: November 2012

Collaborative care for depression and anxiety problems

Review: October 2012

Exercise for depression

Review: July 2012

Interventions for treating depression after stroke

Review: May 2008


NHS Evidence

Delirium: Evidence Update April 2012

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

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

Centre for Reviews and Dissemination – December 2011

Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial.


Further information:

The following sources have been searched for evidence published in the previous 12 months: HEFT Policies, NICE, SIGN, Cochrane Library and European Guidelines. Please contact [email protected] for any further information.

For more information on how to make the most use of the HEFT Library Services, visit Visit NHS Evidence to access your guidelines, Cochrane systematic reviews, journals and databases.