Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients

A Systematic Overview. The SENATOR project ONTOP Series

Iosief Abraha, Fabiana Trotta, Joseph M Rimland, Alfonso Cruz-Jentoft, Isabel Lozano-Montoya, Roy L Soiza, Valentina Pierini, Paolo Dessì Fulgheri, Fabrizia Lattanzio, Denis O'Mahony, Antonio Cherubini

Research output: Contribution to journalReview article

58 Citations (Scopus)
4 Downloads (Pure)

Abstract

BACKGROUND: Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making.

METHODS AND FINDINGS: We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95%CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium.

CONCLUSIONS: In older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium.

Original languageEnglish
Article numbere0123090
JournalPloS ONE
Volume10
Issue number6
DOIs
Publication statusPublished - 10 Jun 2015

Fingerprint

Delirium
systematic review
relative risk
confidence interval
music
Confidence Intervals
Geriatrics
meta-analysis
risk assessment
decision making
education
incidence
Risk assessment
therapeutics
Hazards
Music Therapy
Geriatric Assessment
Education
Decision making
Acoustic waves

Keywords

  • Aged
  • Delirium
  • Humans
  • Journal Article
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

Cite this

Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients : A Systematic Overview. The SENATOR project ONTOP Series. / Abraha, Iosief; Trotta, Fabiana; Rimland, Joseph M; Cruz-Jentoft, Alfonso; Lozano-Montoya, Isabel; Soiza, Roy L; Pierini, Valentina; Dessì Fulgheri, Paolo; Lattanzio, Fabrizia; O'Mahony, Denis; Cherubini, Antonio.

In: PloS ONE, Vol. 10, No. 6, e0123090, 10.06.2015.

Research output: Contribution to journalReview article

Abraha, I, Trotta, F, Rimland, JM, Cruz-Jentoft, A, Lozano-Montoya, I, Soiza, RL, Pierini, V, Dessì Fulgheri, P, Lattanzio, F, O'Mahony, D & Cherubini, A 2015, 'Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series', PloS ONE, vol. 10, no. 6, e0123090. https://doi.org/10.1371/journal.pone.0123090
Abraha, Iosief ; Trotta, Fabiana ; Rimland, Joseph M ; Cruz-Jentoft, Alfonso ; Lozano-Montoya, Isabel ; Soiza, Roy L ; Pierini, Valentina ; Dessì Fulgheri, Paolo ; Lattanzio, Fabrizia ; O'Mahony, Denis ; Cherubini, Antonio. / Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients : A Systematic Overview. The SENATOR project ONTOP Series. In: PloS ONE. 2015 ; Vol. 10, No. 6.
@article{58eb4579f1e946989b70f7d476234f7a,
title = "Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series",
abstract = "BACKGROUND: Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making.METHODS AND FINDINGS: We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95{\%} Confidence Interval (CI) 0.59 to 0.86, I2=0{\%}; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95{\%}CI 0.49 to 0.86, I2=0{\%}; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95{\%}CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95{\%}CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium.CONCLUSIONS: In older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium.",
keywords = "Aged, Delirium, Humans, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review",
author = "Iosief Abraha and Fabiana Trotta and Rimland, {Joseph M} and Alfonso Cruz-Jentoft and Isabel Lozano-Montoya and Soiza, {Roy L} and Valentina Pierini and {Dess{\`i} Fulgheri}, Paolo and Fabrizia Lattanzio and Denis O'Mahony and Antonio Cherubini",
note = "The research leading to these results has received funding from the European Union Seventh Framework program (FP7/2007-2013) under grant agreement n° 305930 (SENATOR). The funders had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.",
year = "2015",
month = "6",
day = "10",
doi = "10.1371/journal.pone.0123090",
language = "English",
volume = "10",
journal = "PloS ONE",
issn = "1932-6203",
publisher = "PUBLIC LIBRARY SCIENCE",
number = "6",

}

TY - JOUR

T1 - Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients

T2 - A Systematic Overview. The SENATOR project ONTOP Series

AU - Abraha, Iosief

AU - Trotta, Fabiana

AU - Rimland, Joseph M

AU - Cruz-Jentoft, Alfonso

AU - Lozano-Montoya, Isabel

AU - Soiza, Roy L

AU - Pierini, Valentina

AU - Dessì Fulgheri, Paolo

AU - Lattanzio, Fabrizia

AU - O'Mahony, Denis

AU - Cherubini, Antonio

N1 - The research leading to these results has received funding from the European Union Seventh Framework program (FP7/2007-2013) under grant agreement n° 305930 (SENATOR). The funders had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.

PY - 2015/6/10

Y1 - 2015/6/10

N2 - BACKGROUND: Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making.METHODS AND FINDINGS: We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95%CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium.CONCLUSIONS: In older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium.

AB - BACKGROUND: Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making.METHODS AND FINDINGS: We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95%CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium.CONCLUSIONS: In older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium.

KW - Aged

KW - Delirium

KW - Humans

KW - Journal Article

KW - Meta-Analysis

KW - Research Support, Non-U.S. Gov't

KW - Review

U2 - 10.1371/journal.pone.0123090

DO - 10.1371/journal.pone.0123090

M3 - Review article

VL - 10

JO - PloS ONE

JF - PloS ONE

SN - 1932-6203

IS - 6

M1 - e0123090

ER -