WHO is developing its first global guideline on prevention, diagnosis and management of delirium in older adults, with medication safety and deprescribing as core parts. For people with mild cognitive impairment, which means thinking or memory changes that do not remove daily independence, that work points to medication review and clear consent checks before joining research. Delirium means a sudden change in attention and awareness, often triggered in hospital or illness. Deprescribing means a planned process to lower doses or stop drugs when harm outweighs benefit, with monitoring and follow-up.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- What WHO is building in 2026
- Which medicines raise concern
- Why stopping a drug still needs a plan
- Can people with mild cognitive impairment join studies
- Questions to ask before you say yes
What WHO is building in 2026
WHO states that medication-related factors including polypharmacy and inappropriate prescribing are major contributors to delirium risk, according to WHO's call for experts. The same WHO notice describes a Guideline Development Group and External Review Group to shape the recommendations.
The effort is explicitly global and aimed at older adults. It places medication safety alongside prevention, diagnosis and management, not as an afterthought.
Which medicines raise concern
The American Geriatrics Society advises avoiding anticholinergics, benzodiazepines, nonbenzodiazepine sedatives and routine antipsychotics in older adults because they increase delirium, falls, cognitive impairment and hospitalization, according to the 2023 Beers Criteria update. These are common sleep, anxiety, allergy and bladder drugs, plus sedating pain and behavioral drugs.
Researchers also validated STOPPCog as 23 explicit criteria for cognitively vulnerable older people. The groups cover daily anticholinergics, sedatives, drugs that worsen psychosis, chronic-pain drugs, unproven dementia drugs and futile drugs in late dementia.
Why stopping a drug still needs a plan
A hospital start can become long-term use without a clear review. Only 15.4% of older multimorbid patients newly started on an atypical antipsychotic in hospital for a potentially inappropriate indication had it stopped within two months after discharge, as reported in a 2025 journal review.
That pattern matters for families because delirium treatment choices carry tradeoffs. Bring a full drug list to every admission, ask what each new brain-active drug is for, and ask when it will be reviewed, tapered or stopped.
Can people with mild cognitive impairment join studies
Many trials include people with mild cognitive impairment when they can show they understand the choice. Trials commonly use the UCSD Brief Assessment of Capacity to Consent, where a score above 14.5 defines independent consent, as described in a 2023 Behavioral Sciences review.
One MCI trial checks understanding by asking for the study purpose, the risks, and whether withdrawal is allowed at any time. Expect the same three ideas in other brain-health studies, even when the exact form differs.
Questions to ask before you say yes
Take notes, bring a partner, and ask for the answers in writing. Do not sign while rushed, sedated or acutely ill.
- What is the purpose of this study in plain language
- What are the risks, time demands and follow-up visits
- Can I withdraw at any time without losing regular care
- Who reviews my current medicines for delirium risk during the study
- Who should my family or proxy contact if confusion appears suddenly
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