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Multicomponent intervention strategies for managing delirium in hospitalized older people: systematic review.

AIM
The aim of this systematic review was to determine the characteristics and efficacy of various multicomponent intervention strategies for delirium in hospitalized older people.


BACKGROUND
Delirium is a common accompaniment to acute illness in hospitalized older people and has greater costs of care concurrent as well as greater morbidity and mortality.


METHODS
A comprehensive search was undertaken involving all major databases (including the Cochrane Library, Medline, Cumulative Index for Nursing and Allied Health Literature and Invert) and reference lists of all relevant papers. Selection criteria were: evaluation of a multicomponent intervention for delirium, inclusion of an operational definition for delirium consistent with the Diagnostic and Statistical Manual of Mental Disorders-criteria, randomized controlled trials, studies with a quasi-experimental design and reporting on primary data. To generate a description of the characteristics of these multicomponent strategies, the components of these programmes were identified and categorized. Effects on incidence of delirium, cognitive functioning, duration and severity of delirium, functional status, hospital length of stay, and mortality were analysed.


FINDINGS
Three randomized controlled trials, three controlled studies and one before-after study were identified. Intervention strategies to prevent delirium proved to be the most efficacious in reducing its incidence, both with surgical and medical patients. Some additional positive effects of preventive strategies were found on the duration and severity of delirium, and functional status. Conversely, strategies to treat delirium were rather ineffective in older people admitted to medical services. In a population of older people admitted for surgery, however, a shorter duration and a diminished severity of delirium were demonstrated. None of intervention strategies produced beneficial effects on length of stay or mortality.


CONCLUSION
Multicomponent interventions to prevent delirium are the most effective and should be implemented through synergistic cooperation between the various healthcare disciplines. Nurses should play a pivotal role in prevention, early recognition and treatment.