Preventing delirium in an acute hospital using a non-pharmacological intervention

Abstract

Background: delirium is a clinical syndrome associated with multiple short and long-term complications and therefore prevention is an essential part of its management. This study was designed to assess the efficacy of multicomponent intervention in delirium prevention. Methods: a total of 287 hospitalised patients at intermediate or high risk of developing delirium were randomised to receive a non-pharmacological intervention delivered by family members (144 patients) or standard management (143 patients). The primary efficacy outcome was the occurrence of delirium at any time during the course of hospitalisation. Three validated observers performed the event adjudication by using the confusion assessment method screening instrument. Results: there were no significant differences in the baseline characteristics between the two groups. The primary outcome occurred in 5.6% of the patients in the intervention group and in 13.3% of the patients in the control group (relative risk: 0.41; confidence interval: 0.19-0.92; P = 0.027). Conclusion: the results of this study show that there is a benefit in the non-pharmacological prevention of delirium using family members, when compared with standard management of patients at risk of developing this condition.

Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series

“…In Asplund et al[75] where delirium was not a primary outcome and patients were at low risk of developing delirium, non-pharmacological interventions were not able to prevent delirium [RR 1.75 (95% CI 0.50 to 6.10), GRADE quality of evidence was very low]. Conversely, in Martinez et al[74] patients were at high risk of delirium (age >70 years, a documented cognitive impairment, alcoholism and metabolic imbalances) and the multicomponent intervention, which was performed by family members, was able to reduce the incidence of delirium (evaluated daily with the CAM) by 58% [RR 0.42 (95% CI 0.19 to 0.92)GRADE quality of evidence was low][74]. …”

The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial

“…In studies regarding the non-pharmacologic, multicomponent, and multi-disciplinary counseling protocol for delirium prevention, the intervention was found to be effective in reducing the incidence of delirium (Deschodt et al, 2012;Inouye et al, 1999;Martinez et al, 2012). A .71 a reduced delirium incidence, length of hospitalization, and medical costs were observed in a study regarding the application of a specialized delirium prevention program, which was developed as part of the Hospital Elder Life Program for hospitalized elderly patients (Rubin et al, 2011).…”

Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial

“…It was performed in all afternoon sessions; and f) Family participation: daily visits by trained family members [21].…”