Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature

Martínez, Felipe; Tobar, Catalina; Hill, Nathan R.

doi:10.1093/ageing/afu173

Cited by 159 publications

(126 citation statements)

References 38 publications

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…Although our preliminary outcomes need to be confirmed in a larger, randomized trial, which is planned to be performed, the results are comparable to those presented in the recent meta-analysis by Martinez et al Martinez and colleagues pooled 3 studies with a total number of 582 patients [19, 20, 23] and a nonsignificant reduction in in-hospital mortality was observed [8]. Among these, only Vidán et al's study found a statistically significant increase in preventing in-hospital deaths for patients allocated to the intervention [23].…”

Section: Discussionsupporting

confidence: 79%

“…Most importantly, at least 30% to 40% of cases of delirium are potentially preventable [6, 7]. Currently, there is no rationale for pharmacological prophylaxis of delirium, whereas nonpharmacological interventions are widely supported by growing evidence from clinical trials, systematic reviews, and meta-analyses [8–10]. Delirium usually has a multifactorial etiology.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

Górski

Piotrowicz

Rewiuk

et al. 2017

BioMed Research International

View full text Add to dashboard Cite

Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.

show abstract

Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

Górski

Piotrowicz

Rewiuk

et al. 2017

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…In a meta-analysis of 14 interventional studies based on the Hospital Elder Life Program, 57,58 these approaches significantly reduced the risk of incident delirium by 53% (odds ratio, 0.47 [95% CI, 0.38–0.58]), and the risk of falls by 62% (odds ratio, 0.38 [95% CI, 0.25–0.60]) among hospitalized, non-ICU patients 65 years and older. 22 …”

Section: Resultsmentioning

confidence: 99%

Delirium in Older Persons

Fong

Hshieh

et al. 2017

JAMA

687

306

View full text Add to dashboard Cite

Importance-Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effect with substantial health care costs.Objective-To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field.Evidence Review-We searched Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011 until March 16, 2017 using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded.Findings-Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment, 4 A's test, and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method-Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of

show abstract

“…Demographic and physical factors are age, gender, hospitalized days, institutionalization, trauma history, surgery, heart and lung illness, hypertension, diabetes, chronic kidney failure, gastrointestinal diseases, urinary and genital illness, metabolic disorders, central nervous system illness, peripheral vascular disease, stroke, dementia, malnutrition, fever, low albumin, low oxygen, dehydration, electronic imbalance, azotemia, infection, convulsion, and multiple or pain medications [1,2,4,5,[7][8][9][11][12][13][14][15][16][17][18]. Specifically, 3% to 5% of elderly people who have had hip and knee surgeries would experience acute confusion or delirium for a specific period.…”

Section: Related Factors Of Elderly Deliriummentioning

confidence: 99%

“…Moreover, delaying the time of delirium might increase the incidence of illness, patients' dependence, the needs of nursing homes, and death rates because of the heavy burden on the health care system and society [1,4,5,7,9,10,14,16,18,19]. In addition, a study reported that urinary tract infection (UTI) rates in elderly patients with delirium ranged from 25.9% to 32% compared with 13% in those without delirium; in patients with UTI, delirium rates ranged from 30% to 35%, compared with 7.7% to 8% in those without UTI [11].…”

Section: Consequences Of Elderly Deliriummentioning

confidence: 99%

Integrate Literature Review of Delirium on the Elders

Chen¹,

Ku²

2017

J Gerontol Geriatr Res

View full text Add to dashboard Cite

Delirium is a common problem for elderly hospitalized patients and those transferred from one place to another. The risk of delirium increases considerably with age. This article provides an integrated review of the literature on delirium in elderly patients; on the basis of this review, the characteristics of elderly delirium can be defined as follows: acute confusion with fluctuating changes in consciousness, orientation, attention, perceptions, emotion, thinking, sleeping patterns, and behaviors, which could develop and disappear in a short period. The related factors of elderly delirium include demographic and physical factors, as well as cognitive, functional, psychosocial, and other factors. Furthermore, scales for assessing elderly delirium include the short portable mental status questionnaire, mini-mental status examination, Confusion Assessment Method-ICU (CAM-ICU), delirium observation screening scale, NEECHAM Confusion Scale, Groningen Frailty Indicator, and Hasegawa's Dementia Scale-Revised. Although the CAM-ICU has the least items and affords the fastest assessment, it lacks the items to measure orientation, perceptions, emotions, sleeping patterns, and behaviors, which are the characteristics of elderly delirium identified in the integrated literature review. Based on the literature review findings, the authors recommend that future studies should develop a comprehensive delirium assessment scale for elderly patients, including the related factors and defining characteristics, thus enabling health care professionals to care for and manage delirium problems effectively and efficiently. Moreover, the authors suggest developing an assessment scale to distinguish between the three problems (delirium, dementia, and depression) and reduce misdiagnosis rates, which would result in reduced hospitalization times, death rates, cost to the health care system, and patients being transferred to nursing homes.©

show abstract

Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature

Cited by 159 publications

References 38 publications

Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

Delirium in Older Persons

Integrate Literature Review of Delirium on the Elders

Contact Info

Product

Resources

About