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- Title
2015 - Review: Multicomponent nonpharmacologic interventions reduce incident delirium in inpatients.
- Authors
Hirsch, Calvin
- Abstract
Question In older hospitalized patients, do nonpharmacologic multicomponent interventions (NPMIs) reduce incident delirium? Review scope Included studies compared NPMIs to prevent delirium with controls in hospital inpatients and measured delirium incidence during hospitalization with a validated delirium instrument. Studies were included if the mean or median age of included patients was ≥ 65 years. Studies of patients with terminal illness were excluded. Outcomes included delirium incidence, falls, length of hospital stay, discharge to institution, change in functional status, and change in cognitive status. Review methods MEDLINE, Cochrane Database of Systematic Reviews, ScienceDirect, Google Scholar, and reference lists (1999 to Dec 2013) were searched for studies published in English. Qualitative studies, case series, reviews, and cost-effectiveness analyses were excluded. 14 studies (n = 4267, mean age 80 y), with durations of 3 to 36 months, met the selection criteria. 4 randomized controlled trials (RCTs), 2 matched studies, and 8 studies with unmatched or historical controls were included. Settings were acute medical and surgical wards. 9 studies used ≥ 4 of 6 evidence-based interventions (cognition or orientation, early mobility, hearing, sleep-wake cycle preservation, vision, and hydration). Main results Meta-analysis of RCTs and matched studies showed that multicomponent nonpharmacologic interventions reduced risk for incident delirium and falls (Table). Intervention and control groups did not differ for hospital length of stay, discharge to institution (Table), change in functional status, or change in cognitive status. Conclusion In older hospitalized patients, multicomponent nonpharmacologic delirium prevention interventions reduce incident delirium.
- Subjects
EYEGLASSES; HOSPITAL care of older people; ANTIPSYCHOTIC agents; COGNITION; CONFIDENCE intervals; CRITICAL care medicine; DATABASES; DRINKING (Physiology); DELIRIUM; ACCIDENTAL falls; HEARING aids; LENGTH of stay in hospitals; INFORMATION storage &; retrieval systems; MEDICAL databases; MEDICAL information storage &; retrieval systems; LIFE skills; MEDLINE; META-analysis; PATIENT safety; SLEEP; SYSTEMATIC reviews; PSYCHOSOCIAL factors; BODY movement; RANDOMIZED controlled trials; RELATIVE medical risk; DESCRIPTIVE statistics; OLD age; PREVENTION
- Publication
ACP Journal Club, 2015, Vol 163, Issue 2, p3
- ISSN
1056-8751
- Publication type
Article