Effectiveness of Multicomponent Nonpharmacological Delirium Interventions: A Meta-analysis
Tammy T. Hshieh,Jirong Yue,Esther S. Oh,Margaret R. Puelle,Sarah L. Dowal,Thomas G. Travison,Sharon K. Inouye +6 more
TLDR
A meta-analysis supports the use of multicomponent nonpharmacological delirium prevention interventions to advance acute care for older persons, with a trend toward decreasing length of stay and avoiding institutionalization.Abstract:
MAIN OUTCOMES AND MEASURES We identified 14 interventional studies. The results for outcomes of delirium incidence, falls, length of stay, and institutionalization were pooled for the meta-analysis, but heterogeneity limited our meta-analysis of the results for change in functional or cognitive status. Overall, 11 studies demonstrated significant reductions in delirium incidence (odds ratio [OR], 0.47; 95% CI, 0.38-0.58). Four randomized or matched trials reduced delirium incidence by 44% (OR, 0.56; 95% CI, 0.42-0.76). The rate of falls decreased significantly among intervention patients in 4 studies (OR, 0.38; 95% CI, 0.25-0.60); in 2 randomized or matched trials, the rate of falls was reduced by 64% (OR, 0.36; 95% CI, 0.22-0.61). Length of stay and institutionalization also trended toward decreases in the intervention groups, with a mean difference of −0.16 (95% CI, −0.97 to 0.64) day shorter and the odds of institutionalization 5% lower (OR, 0.95; 95% CI, 0.71-1.26). Among higher-quality randomized or matched trials, length of stay trended −0.33 (95% CI, −1.38 to 0.72) day shorter, and the odds of institutionalization trended 6% lower (OR, 0.94; 95% CI, 0.69-1.30).read more
Citations
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American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
TL;DR: The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care and should lead to closer monitoring of drug use in older adults.
Journal ArticleDOI
European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium
Cesar Aldecoa,Gabriella Bettelli,Federico Bilotta,Robert D. Sanders,Riccardo A. Audisio,Anastasia Borozdina,Antonio Cherubini,Christina Jones,Henrik Kehlet,Alasdair M.J. MacLullich,Finn M. Radtke,Florian Riese,Arjen J.C. Slooter,Francis Veyckemans,Sylvia Kramer,Bruno Neuner,Bjoern Weiss,Claudia Spies +17 more
TL;DR: This guideline is aimed to promote knowledge and education in the preoperative, intraoperative and postoperative setting not only among anaesthesiologists but also among all other healthcare professionals involved in the care of surgical patients.
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Delirium in Older Persons: Advances in Diagnosis and Treatment.
TL;DR: Avoiding use of antipsychotics and other sedating medications for treatment of severe agitation that poses risk to patient or staff safety or threatens interruption of essential medical therapies is recommended.
Journal ArticleDOI
Delirium in Hospitalized Older Adults
TL;DR: Proactive, multifactorial interventions and geriatrics consultation have been shown to reduce the incidence, severity, and duration of delirium.
Journal ArticleDOI
Interventions for preventing delirium in hospitalised non-ICU patients
Najma Siddiqi,Jennifer K. Harrison,Andrew Clegg,Elizabeth Teale,John Young,James Taylor,Samantha A Simpkins +6 more
TL;DR: Multi-component interventions reduced the incidence of delirium compared to usual care for patients treated with an atypical antipsychotic medications and for patients with pre-existing dementia, but the effect of multi- component interventions remains uncertain.
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Clarifying Confusion: The Confusion Assessment Method: A New Method for Detection of Delirium
TL;DR: The CAM is sensitive, specific, reliable, and easy to use for identification of delirium and was shown to have convergent agreement with four other mental status tests, including the Mini-Mental State Examination.
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A multicomponent intervention to prevent delirium in hospitalized older patients.
Sharon K. Inouye,Sidney T. Bogardus,Peter Charpentier,Linda Leo-Summers,Denise Acampora,Theodore R. Holford,Leo M. Cooney +6 more
TL;DR: The intervention was associated with significant improvement in the degree of cognitive impairment among patients with cognitive impairment at admission and a reduction in the rate of use of sleep medications among all patients, suggesting that primary prevention of delirium is probably the most effective treatment strategy.
Journal ArticleDOI
Delirium in elderly people
TL;DR: In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological risk factor approaches are the most effective strategy for prevention and no convincing evidence shows that pharmacological prevention or treatment is effective.
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