A systematic review 1 including 8 prevention trials (4 RCTs) with a total of 1051 subjects and 13 treatment trials (3 RCTs) with a total of 1395 subjects was abstracted in DARE. Since then two large prevention trials 2, 3 are published. The absolute risk reductions among surgical patients ranged from -13% to 36% among surgical patients and from -3% to 34% among elderly medical patients. Non-pharmacotherapy interventions appeared to have a beneficial effect on the cognitive and functional status of surgical patients and a modest beneficial effect on elderly medical patients. For pharmacotherapy, results from one RCT suggested that haloperidol and chlorpromazine were more useful than lorazepam in improving delirium in younger AIDS patients, one cohort study reported that talopeidol was more useful than narcotics in controlling delirium in older cardiac patients, and two non-randomised trials reported that mianserin was as effective as haloperidol in controlling symptoms in older medical-surgical and psychiatric patients.
In the latest randomized trial 4 multidisciplinary geriatric assessment and consultation did not appear to be more effective than normal treatment model in the outcomes of delirium (mortality, institutional placement, length of hospital stay, cognition).
Comment: The quality of evidence is downgraded by study quality (limitations in original studies), by inconsistency (heterogeneity in interventions), by indirectness (differences in studied patients), and by potential reporting bias (only few small trials reported).
Primary/Secondary Keywords