Acupuncture Treatment of Delirium in Older Adults Hospitalized in Internal Medicine Departments: An Open-Label Pragmatic Randomized-Controlled Trial

Abstract

Background: Acupuncture seems to improve cognitive function in experimental models and to reduce agitation in dementia. The addition of acupuncture to standard-of-care (SOC) may improve clinical outcomes related to delirium in hospitalized older adults. Methods: This pragmatic open-label randomized-controlled trial evaluated 81 older adults hospitalized in an internal medicine ward and diagnosed with delirium. Fifty were randomized to daily acupuncture combined with SOC and 31 to SOC only for up to 1 week. Delirium was diagnosed using Confusion Assessment Method (CAM) tool, and its severity was assessed by the long CAM-Severity (CAM-S) tool. The primary study outcome was delirium resolution evaluated as time-to-first delirium remission (over 7 days) and the number of days spent delirium-free. Results: Time-to-first delirium remission was shorter in the acupuncture arm as compared to the SOC only arm (p < 0.001). A multivariate Cox regression analysis showed a shorter time-to-first remission of delirium in the acupuncture arm as compared with SOC arm [Hazard Ratio 0.267 (95% CI 0.098-0.726, p = 0.010)]. In the 7 days of evaluation, a significantly higher number of delirium-free days was found in the acupuncture arm compared to the SOC arm (p < 0.001), and CAM-S sum from day 2 to day 7 of evaluation was significantly lower in the acupuncture group compared to the control group (p = 0.002). No adverse safety event was found in the acupuncture group. Conclusion: Acupuncture seems to be safe and effective in the treatment of delirium in older patients hospitalized in internal medicine departments.

Role of acupuncture in critically ill patients: A systematic review

“…Between-group comparison analysis of hepatic and renal function and severe adverse reactions all showed no significant difference between the three groups. Matsumoto-Miyazaki 18 Case-control: 30 ventilated ICU patients vs. 29 historical controls Combination therapy: acupuncture and traditional herbal medicine (Kamikihito) for reducing the incidence of delirium in patients with cardiovascular disease. Acupuncture points were GV20, Ex-HN3, HT7, LI4, LR3, and KI3.…”

“…37 A recent study showed a shorter time-to-first remission of delirium in the acupuncture vs. the standard care arm among hospitalized patients, as well as a significantly higher number of delirium-free days in the acupuncture arm. 18 In a study in the ICU setting which evaluated the use of once-daily acupuncture treatment, associated to the administration of a TCM herbal formula administered orally three times a day during the first week of the ICU stay, the incidence rates of delirium, assessed using the confusion assessment method for ICU, in the treatment and control period were significantly lower in the treatment group than in the control group. 38 In summary, acupuncture seems an effective part of a non-pharmacological strategy to manage agitation, pain and delirium in the ICU.…”

Advances in the prevention and treatment of postoperative delirium by acupuncture: A review

“…[ 20 , 21 ] A systematic review and meta-analysis confirmed that acupuncture can decrease the State-Trait Anxiety Inventory and Visual Analogue Scale scores of preoperative anxiety in patients, as compared to control groups or sham therapy. [ 15 , 22 ] Acupuncture can also improve the cognitive function of dementia patients and reduce their agitation, a randomized study by Levy et al [ 23 ] proved that acupuncture was safe and effective in the treatment of delirium, when served as an addition to standard-of-care, acupuncture might improve clinical outcomes related to delirium in older patients hospitalized in internal medicine departments, which was manifested in shortening time-to-first delirium remission, increasing the number of delirium-free days, and lowering the severity of delirium. Similarly, a combination of acupuncture and herbal medicine adopted by Matsumoto-Miyazaki et al [ 24 ] was found to be effective in reducing the occurrence of delirium and exhibiting no serious adverse events in patients with cardiovascular disease in intensive care units.…”

Trends in research on the perioperative use of acupuncture in the last 20 years: A CiteSpace-based bibliometric analysis and literature review

“…Postoperative brain function has attracted great attentions. For example, there has been researches on post-operative delirium [35], post-operative cognitive dysfunction [36,37] and the sleep mode [38]. The keyword analysis results provide hints for research frontiers.…”