Felipe Martinez1, Catalina Tobar2, Nathan Hill3. 1. Centro de Investigaciones Biomedicas, Universidad de Valparaiso, Valparaiso, Chile Departamento de Salud Publica, Universidad de Valparaiso, Valparaiso, Chile. 2. Departamento de Medicina Interna, Universidad de Valparaiso, Valparaiso, Chile Escuela de Medicina, Universidad de Valparaiso, Valparaiso, Chile. 3. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Abstract
BACKGROUND: Delirium is a complex neuropsychiatric syndrome that is common among elderly inpatients. It has been associated with increased mortality, longer hospital stays, cognitive and functional decline and increased institutionalisation rates. Multicomponent interventions, a series of non-pharmacological strategies frequently handled by nursing staff, might be useful for prevention. OBJECTIVES: To assess the efficacy of multicomponent interventions in preventing incident delirium in the elderly. METHODS: A systematic review of randomised trials was undertaken. Two independent reviewers performed iterative literature searches in seven databases without language restrictions. Grey literature repositories were considered as well. The quality of included trials was assessed by using the criteria established by the Cochrane Collaboration. When possible, data were synthesised into a meta-analysis. Heterogeneity was assessed using the χ2 and I2 tests. FINDINGS: A total of 21,788 citations were screened, and seven studies of diverse quality were included in the review, comprising 1,691 participants. Multicomponent interventions significantly reduced incident delirium (relative risk [RR] 0.73, 95% confidence interval [CI] 0.63-0.85, P<0.001) and accidental falls during the hospitalisation (RR 0.39, 95% CI 0.21, 0.72, P=0.003), without evidence of differential effectiveness according to ward type or dementia rates. Non-significant reductions in delirium duration, hospital stay and mortality were found as well. INTERPRETATION: Multicomponent interventions are effective in preventing incident delirium among elderly inpatients. Effects seemed to be stable among different settings. Due to the limited amount of data, potential benefits in survival need to be confirmed in further studies. Future research should be aimed at contrasting different multicomponent programmes to select the most useful interventions.
BACKGROUND:Delirium is a complex neuropsychiatric syndrome that is common among elderly inpatients. It has been associated with increased mortality, longer hospital stays, cognitive and functional decline and increased institutionalisation rates. Multicomponent interventions, a series of non-pharmacological strategies frequently handled by nursing staff, might be useful for prevention. OBJECTIVES: To assess the efficacy of multicomponent interventions in preventing incident delirium in the elderly. METHODS: A systematic review of randomised trials was undertaken. Two independent reviewers performed iterative literature searches in seven databases without language restrictions. Grey literature repositories were considered as well. The quality of included trials was assessed by using the criteria established by the Cochrane Collaboration. When possible, data were synthesised into a meta-analysis. Heterogeneity was assessed using the χ2 and I2 tests. FINDINGS: A total of 21,788 citations were screened, and seven studies of diverse quality were included in the review, comprising 1,691 participants. Multicomponent interventions significantly reduced incident delirium (relative risk [RR] 0.73, 95% confidence interval [CI] 0.63-0.85, P<0.001) and accidental falls during the hospitalisation (RR 0.39, 95% CI 0.21, 0.72, P=0.003), without evidence of differential effectiveness according to ward type or dementia rates. Non-significant reductions in delirium duration, hospital stay and mortality were found as well. INTERPRETATION: Multicomponent interventions are effective in preventing incident delirium among elderly inpatients. Effects seemed to be stable among different settings. Due to the limited amount of data, potential benefits in survival need to be confirmed in further studies. Future research should be aimed at contrasting different multicomponent programmes to select the most useful interventions.
Authors: Giuseppe Bellelli; Alessandro Morandi; Marco Trabucchi; Guido Caironi; Daniele Coen; Carlo Fraticelli; Ciro Paolillo; Carolina Prevaldi; Angela Riccardi; Gianfranco Cervellin; Corrado Carabellese; Salvatore Putignano; Stefania Maggi; Antonio Cherubini; Paola Gnerre; Andrea Fontanella; Nicola Latronico; Concezione Tommasino; Antonio Corcione; Giovanni Ricevuti; Nicola Ferrara; Francesco De Filippi; Alberto Ferrari; Mario Guarino; Maria Pia Ruggieri; Pietro Amedeo Modesti; Carlo Locatelli; Patrizia Hrelia; Marco Otto Toscano; Emi Bondi; Antonio Tarasconi; Luca Ansaloni; Francesco Perticone Journal: Intern Emerg Med Date: 2017-07-24 Impact factor: 3.397
Authors: Jennifer K Burton; Louise Craig; Shun Qi Yong; Najma Siddiqi; Elizabeth A Teale; Rebecca Woodhouse; Amanda J Barugh; Alison M Shepherd; Alan Brunton; Suzanne C Freeman; Alex J Sutton; Terry J Quinn Journal: Cochrane Database Syst Rev Date: 2021-11-26
Authors: Emily J Tomlinson; Helen Rawson; Elizabeth Manias; Nicole Nikki M Phillips; Peteris Darzins; Alison M Hutchinson Journal: BMJ Open Date: 2021-07-07 Impact factor: 2.692
Authors: Jennifer K Burton; Louise E Craig; Shun Qi Yong; Najma Siddiqi; Elizabeth A Teale; Rebecca Woodhouse; Amanda J Barugh; Alison M Shepherd; Alan Brunton; Suzanne C Freeman; Alex J Sutton; Terry J Quinn Journal: Cochrane Database Syst Rev Date: 2021-07-19