Non-pharmacological approaches in the prevention of delirium

Salvi, F.; Young, John; Lucarelli, Moira; Aquilano, Alessandra; Luzi, Riccardo; Dell’Aquila, Giuseppina; Cherubini, Antonio

doi:10.1007/s41999-019-00260-7

Cited by 18 publications

(17 citation statements)

References 66 publications

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“…Preoperative stratification of patients based on estimated risk for postoperative delirium could identify those patients expected to benefit most from preventive measures. Although there is no conclusive evidence that different drugs are effective in preventing delirium,39 the evidence for non-pharmacological multicomponent interventions is considered sufficiently robust for clinical practice recommendations in elderly non-ICU patients 6. In healthcare institutions, applying multicomponent non-pharmacological measures to all patients would result in a high burden on scarce human and material resources.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is no conclusive evidence that different drugs are effective in preventing delirium, 39 the evidence for non-pharmacological multicomponent interventions is considered sufficiently robust for clinical practice recommendations in elderly non-ICU patients. 6 In healthcare institutions, applying multicomponent non-pharmacological measures to all patients would result in a high burden on scarce human and material resources. The labour-intensive and costly nature of multicomponent interventions requires appropriate selection of patients who are expected to benefit most from such interventions or for whom certain interventions could be omitted.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, delirium is considered preventable in up to 40% of the cases 4 5. For example, non-pharmacological multicomponent interventions were shown effective in reducing the risk of developing delirium in the elderly 6. Yet, these interventions can be time-consuming and costly, limiting widespread application when resources are scarce.…”

Section: Introductionmentioning

confidence: 99%

“… 4 5 For example, non-pharmacological multicomponent interventions were shown effective in reducing the risk of developing delirium in the elderly. 6 Yet, these interventions can be time-consuming and costly, limiting widespread application when resources are scarce. Adequate stratification of delirium risk is of great importance to make sure preventive interventions are provided to those patients expected to benefit most from them.…”

Section: Introductionmentioning

confidence: 99%

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Head-to-head comparison of 14 prediction models for postoperative delirium in elderly non-ICU patients: an external validation study

et al. 2022

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ObjectivesDelirium is associated with increased morbidity, mortality, prolonged hospitalisation and increased healthcare costs. The number of clinical prediction models (CPM) to predict postoperative delirium has increased exponentially. Our goal is to perform a head-to-head comparison of CPMs predicting postoperative delirium in non-intensive care unit (non-ICU) elderly patients to identify the best performing models.SettingSingle-site university hospital.DesignSecondary analysis of prospective cohort study.Participants and inclusionCPMs published within the timeframe of 1 January 1990 to 1 May 2020 were checked for eligibility (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). For the time period of 1 January 1990 to 1 January 2017, included CPMs were identified in systematic reviews based on prespecified inclusion and exclusion criteria. An extended literature search for original studies was performed independently by two authors, including CPMs published between 1 January 2017 and 1 May 2020. External validation was performed using a surgical cohort consisting of 292 elderly non-ICU patients.Primary outcome measuresDiscrimination, calibration and clinical usefulness.Results14 CPMs were eligible for analysis out of 366 full texts reviewed. External validation was previously published for 8/14 (57%) CPMs. C-indices ranged from 0.52 to 0.74, intercepts from −0.02 to 0.34, slopes from −0.74 to 1.96 and scaled Brier from −1.29 to 0.088. Based on predefined criteria, the two best performing models were those of Dai et al (c-index: 0.739; (95% CI: 0.664 to 0.813); intercept: −0.018; slope: 1.96; scaled Brier: 0.049) and Litaker et al (c-index: 0.706 (95% CI: 0.590 to 0.823); intercept: −0.015; slope: 0.995; scaled Brier: 0.088). For the remaining CPMs, model discrimination was considered poor with corresponding c-indices <0.70.ConclusionOur head-to-head analysis identified 2 out of 14 CPMs as best-performing models with a fair discrimination and acceptable calibration. Based on our findings, these models might assist physicians in postoperative delirium risk estimation and patient selection for preventive measures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Head-to-head comparison of 14 prediction models for postoperative delirium in elderly non-ICU patients: an external validation study

et al. 2022

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“…A review of the literature that included broader study types examining nonpharmacological approaches in the prevention of delirium concluded that evidence for multicomponent interventions is sufficiently robust for clinical practice recommendations to be formulated [42]. However, no conclusive outcome effects have been demonstrated for single-component interventions.…”

Section: Delirium Risk Reduction/preventionmentioning

confidence: 99%

Postoperative delirium in older patients with cancer: the role of psychological distress and social support

O’Hanlon

Baxter

Hosie

2021

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewDelirium is a common and important adverse event in the perioperative period. Older people with cancer are at significant risk, and outcomes are poor. There is increasing awareness of the effect of psychological distress and social support on pathogenesis and outcomes of delirium in this setting. This review aimed to describe recent research in this evolving area. Recent findingsAcross six recent studies of postoperative delirium in older people with cancer, delirium incidence ranged from 8 to 19.8%. Poor social support and high levels of distress are implicated in the development of postoperative delirium. Distress can be related to negative emotional reaction to diagnosis, preconception of cancer diagnosis and interactions with the healthcare system. Prevention of delirium is key, and multicomponent interventions show evidence of effectiveness. 'Emotional distress' has been included in a new core outcome set for studies of interventions to prevent and/or treat delirium.

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Drug Treatment of Other Psychiatric Conditions

2021

The Maudsley Prescribing Guidelines in Psychiatry

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Borderline personality disorder (BPD) is common in psychiatric settings, affecting 20% of community psychiatric patients. Common co‐morbid conditions affecting patients with BPD include affective disorders anxiety spectrum disorders, eating disorders, and drug and alcohol misuse, and the lifetime risk of having at least one co‐morbid mental disorder approaches 100%. Although classified as a personality disorder, several aspects of BPD have been assumed to be responsive to drug treatment. Drug treatments are often used during periods of crisis when symptoms can be severe, distressing and potentially life‐threatening. Psychiatric conditions often coexist with eating disorders, and this may in part explain the benefit sometimes seen with medication. Drugs have limited activity in anorexia nervosa, and none is currently licensed for this condition. Delirium is a common neuropsychiatric condition that presents in medical and surgical settings and is known by various names including organic brain syndrome, intensive care psychosis and acute confusional state.

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Non-pharmacological approaches in the prevention of delirium

Cited by 18 publications

References 66 publications

Head-to-head comparison of 14 prediction models for postoperative delirium in elderly non-ICU patients: an external validation study

Head-to-head comparison of 14 prediction models for postoperative delirium in elderly non-ICU patients: an external validation study

Postoperative delirium in older patients with cancer: the role of psychological distress and social support

Drug Treatment of Other Psychiatric Conditions

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