Research Activities, September 2013
Multicomponent intervention programs are effective in preventing delirium in older hospital patients
Patient Safety and Quality
Delirium, also known as acute confusional state, affects between 14 and 56 percent of older hospitalized patients. It is linked to increased risk for death, postoperative complications, longer hospital and intensive care unit stays, and functional declines.
To lessen or prevent the occurrence of delirium, hospitals have implemented multicomponent interventions. Most are effective in preventing the onset of delirium in at-risk patients in a hospital setting, according to a systematic review of 19 studies by a team of researchers with the ECRI Institute. Evidence from the review was insufficient to determine the benefit of such programs in palliative care or long-term care settings. In addition, the evidence was insufficient to identify which multicomponent interventions are most beneficial, and the studies do not address the question of which components within a program provided the most benefit for delirium prevention.
Many factors contribute to delirium, including age, cognitive impairment or dementia, depression, multiple medications, and procedures such as blood transfusions. In general, successful delirium prevention programs involved a multidisciplinary team of clinical experts, nurses, and other staff such as physical therapists or volunteers, and included protocols for early mobilization of patients, volume repletion (for hydration and electrolyte balance), and addressing visual or hearing deficits. A few programs included elimination of unnecessary medications.
Future comparative effectiveness studies will be needed to identify which components in multicomponent interventions are most effective for delirium prevention. This study was supported by AHRQ (Contract No. 90-07-10062).
See "In-facility delirium prevention programs as a patient safety strategy. A systematic review," by James T. Reston, Ph.D., and Karen M. Schoelles, M.D., in the March 5, 2013, Annals of Internal Medicine 158(5) Part 2, pp. 375-380.