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

Felipe Martinez, Catalina Tobar, Nathan Hill

Resultado de la investigación: Article

59 Citas (Scopus)

Resumen

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 X2 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.

Idioma originalEnglish
Número de artículoafu173
Páginas (desde-hasta)196-204
Número de páginas9
PublicaciónAge and Ageing
Volumen44
N.º2
DOI
EstadoPublished - 1 mar 2015

Huella dactilar

Delirium
Meta-Analysis
Inpatients
Length of Stay
Accidental Falls
Confidence Intervals
Institutionalization
Nursing Staff
Hospital Mortality
Dementia
Hospitalization
Language
Databases
Mortality

ASJC Scopus subject areas

  • Ageing
  • Geriatrics and Gerontology

Citar esto

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title = "Preventing delirium: Should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature",
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 X2 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.",
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Preventing delirium : Should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature. / Martinez, Felipe; Tobar, Catalina; Hill, Nathan.

En: Age and Ageing, Vol. 44, N.º 2, afu173, 01.03.2015, p. 196-204.

Resultado de la investigación: Article

TY - JOUR

T1 - Preventing delirium

T2 - Should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature

AU - Martinez, Felipe

AU - Tobar, Catalina

AU - Hill, Nathan

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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 X2 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.

AB - 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 X2 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.

KW - Delirium

KW - Multicomponent interventions

KW - Older people

KW - Primary prevention

UR - http://www.scopus.com/inward/record.url?scp=84925292585&partnerID=8YFLogxK

U2 - 10.1093/ageing/afu173

DO - 10.1093/ageing/afu173

M3 - Article

C2 - 25424450

AN - SCOPUS:84925292585

VL - 44

SP - 196

EP - 204

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 2

M1 - afu173

ER -