WHO's 2026 delirium work makes medication safety and deprescribing central to prevention for older adults, including people with mild cognitive impairment. Established practice supports medication review and avoiding high-risk drugs, while direct benefits of deprescribing for delirium and cognition remain uncertain.
Delirium means sudden confusion, inattention and changed awareness, often triggered during illness or hospital care. Mild cognitive impairment means noticeable memory or thinking changes that do not remove daily independence, but raise vulnerability to delirium. Deprescribing means carefully reducing or stopping a drug whose harms outweigh benefits, under clinical supervision.
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
- Why does mild cognitive impairment raise the stakes?
- Which medication steps are established?
- Which drugs warrant extra caution?
- What remains uncertain about deprescribing?
- What can families do before surgery or admission?
Why does mild cognitive impairment raise the stakes?
People with mild cognitive impairment enter hospital with less cognitive reserve. A sudden stressor such as infection, surgery, dehydration or a new sedating drug can then tip thinking into delirium.
The BMC Geriatrics protocol team reported mild cognitive impairment in about 25% of cardiac-surgery patients, with roughly five- to six-fold higher odds of postoperative delirium. The same research context places delirium in 14-55% of hospitalized older adults. Families should treat any abrupt change in alertness, attention or behavior as urgent.
Which medication steps are established?
The World Health Organization identifies polypharmacy and inappropriate prescribing as major contributors to delirium risk, framing medication review as prevention, according to the WHO call for experts. WHO is developing its first global guideline on prevention, diagnosis and management of delirium in older adults, explicitly including medication safety and deprescribing.
The National Institute for Health and Care Excellence recommends medication review for people taking multiple drugs, weighing both type and number, as part of delirium prevention and management in hospital and long-term care, described in the NICE delirium guideline. Review looks for sedatives, anticholinergics, opioids, antihistamines and recent dose changes or additions. It also checks for missed doses, alcohol use, kidney changes and drug interactions.
Which drugs warrant extra caution?
The American Geriatrics Society advises avoiding anticholinergics, benzodiazepines, nonbenzodiazepine hypnotics and antipsychotics in older adults with delirium or cognitive impairment because they increase delirium, falls and hospitalization, stated in the 2023 AGS Beers Criteria. Common examples include certain sleep aids, anxiety medicines, bladder medicines and allergy medicines with anticholinergic effects.
NICE states distressed adults with delirium who pose risk to self or others should not receive antipsychotics unless de-escalation fails, then only short-term at the lowest dose with cautious titration. Families can ask whether agitation reflects pain, constipation, urinary retention, poor sleep, sensory loss or unfamiliar surroundings. Non-drug calming often comes first: daylight, glasses and hearing aids, hydration, movement, toileting and a familiar presence.
What remains uncertain about deprescribing?
Stopping a risky drug sounds protective, but proof for delirium and memory outcomes is still thin. The British Journal of Clinical Pharmacology systematic review found few trials reporting those outcomes, mixed results, and a 2024 meta-analysis found no overall mortality reduction from deprescribing polypharmacy.
Uncertainty does not mean inaction. It means decisions stay individual, with close follow-up after any taper or stop. Withdrawal, rebound symptoms and return of the original condition need a clear plan and contact point.
What can families do before surgery or admission?
The American Society of Anesthesiologists 2025 perioperative advisory recommends identifying frailty or cognitive deficits before inpatient surgery, with targeted geriatric co-management, deprescribing when indicated and early family education, summarized in the 2025 ASA perioperative advisory summary. A pre-admission cognitive check helps the team plan anesthesia, pain control and ward monitoring. Bring a complete medication list to every encounter:.
- include prescriptions, over-the-counter drugs, sleep aids, allergy pills, supplements and alcohol use
- note recent starts, stops, dose changes, falls, daytime sleepiness, constipation and urinary problems
- ask which medicines could be paused, reduced, substituted or restarted after discharge, and who will monitor the change
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