Non‐Pharmacologic Multicomponent Interventions Preventing Delirium in Hospitalized People

Abstract

BACKGROUND/OBJECTIVES: Delirium is a common neurobehavioral complication in hospitalized patients with a high prevalence in various clinical settings. Prevention of delirium is critical due to its common occurrence and associated poor outcomes. Our objective was to evaluate the efficacy of multicomponent interventions in preventing incident delirium in hospitalized patients at risk. DESIGN: Systematic review and meta-analysis. SETTING: Hospital. PARTICIPANTS: We included a study if it was a randomized controlled trial and was evaluating effects of coordinated non-pharmacologic multicomponent interventions in the prevention of delirium. MEASUREMENTS: We performed a systematic literature search in PubMed and CENTRAL (PROSPERO: CRD42019138981; last update May 24, 2019). We assessed the quality of included studies by using the criteria established by the Cochrane Collaboration. We extracted the measured outcomes for delirium incidence, duration of delirium, length of hospital stay, falls during hospital stay, discharge to institutional care, and inpatient mortality. RESULTS: In total, we screened 1,027 eligible records and included eight studies with 2,105 patients in the review. We found evidence of an effect (ie, reduction) of multicomponent interventions on the incidence of delirium (risk ratio = .53; 95% confidence interval = .41-.69; I 2 = 0). We detected no clear evidence of an effect for delirium duration, length of hospital stay, accidental falls, and mortality. Subgroup analyses did not result in findings of substantial effect modifiers, which can be explained by the high homogeneity within studies. CONCLUSION: Our findings confirm the current guidelines that multicomponent interventions are effective in preventing delirium. Data are still lacking to reach evidence-based conclusions concerning potential benefits for hard outcomes such as length of hospital stay, return to independent living, and mortality.

Delirium

“…A 2018 meta-analysis of 14 HELP studies broadly confirmed these findings and found a reduced rate of falls 255 . In 2013, HELP was expanded by the addition of protocols addressing hypoxia, infection, pain and constipation because these aspects were 258 , with no clear evidence of an effect on duration of delirium, length of stay, falls or mortality; 3 of the 8 studies were based on the HELP protocol. In a planned comparison, there was no difference between HELP-based and other protocols, suggesting that protocols that do not require volunteers can be as effective as those using volunteers.…”

Delirium in COVID-19: common, distressing and linked with poor outcomes. . . can we do better?

“…Multifactorial interventions to prevent delirium may reduce incident delirium by around one-third [ 13 ], but most delirium is prevalent. Identification and treatment of active delirium is therefore a priority.…”

Delirium: A Marker of Vulnerability in Older People

“…The presence and involvement of family members at the patient's bedside has also shown potential efficacy in reducing the incidence of post-operative delirium and the rate of cognitive and physical deterioration at discharge (Wang et al, 2019). More recently, a systematic review integrated the evidence of the multicomponent interventions in ICU and non-ICU settings, confirming the current guidelines that non-pharmacological interventions are effective in preventing delirium, with a global risk ratio = 0.53 (95% CI = 0.41-0.69) (Ludolph et al, 2020).…”