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Evidence Summary

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In older people who are hospitalized, multicomponent interventions that do not include drugs reduce the risk of delirium

Hshieh TT, Yue J, Oh E, et al. Effectiveness of Multicomponent Nonpharmacological Delirium Interventions: A Meta-analysis. JAMA Intern Med. 2015;175:1512-20.

Review question

In older people who are in hospital, do multicomponent interventions that do not include drugs reduce the risk of delirium?

Background

Delirium is a state of confused thinking and reduced mental abilities. Symptoms of delirium can include inability to focus or remember, difficulty speaking or understanding speech, hallucinations, agitation, and extreme emotions. Delirium can result in falls, extended hospital stays, and discharge to long-term care institutions (e.g., nursing homes).

Delirium occurs in 29% to 64% of elderly people who are hospitalized. Therefore, many people may benefit from in-hospital interventions to prevent delirium.

How the review was done

The researchers did a systematic review of studies that were published up to December 2013.

They found 14 studies with 4,267 people (average age 80 years). 4 of the studies were randomized controlled trials, 2 were matched studies, and 8 were studies with unmatched or historical controls. The results of the 6 randomized and matched studies (2,890 people) are reported here.

The key features of the randomized and matched studies were:

  • people did not have delirium before the study began;
  • people were hospitalized in acute medical or surgical wards; and
  • interventions focused on at least 5 of cognitive orientation, early mobility, hearing, sleep–wake cycle preservation, vision, and hydration.

What the researchers found

The quality of the studies varied. The 6 randomized or matched studies had scores of 5 or 6 out of 6 on a scale that measures the quality of the research.

Compared with control interventions, multicomponent non-drug interventions:

  • reduced risk of delirium;
  • reduced falls;
  • did not reduce length of hospital stay or discharge to a long-term care institution; and
  • did not improve the ability to function or think.

Conclusion

In older people who are in hospital, multicomponent interventions that do not include drugs reduce the risk of delirium.

Multicomponent non-drug interventions to reduce risk of delirium in older people in hospital*

Outcomes

Number of studies (and people)

Rate of events with multicomponent interventions

Rate of events with control

Absolute effect of multicomponent interventions

Delirium while in hospital

4 (1,986)

8.1%

14%

About 6 fewer people out of 100 had delirium

Falls

2 (485)

12%

27%

About 15 fewer people out of 100 had a fall

Discharge to a long-term care institution

2 (277)

26%

27%

About 1 less person out of 100 was discharged from hospital to a long-term care institution

*Includes only randomized controlled trials and matched controlled trials.

 




Glossary

Delirium
Sudden and severe confusion that often is caused by physical or mental illness. It is usually temporary and reversible.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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