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Evidence summaries

Interventions for Preventing Delirium in Hospitalised Patients

Multi-component interventions appear to prevent delirium in hospitalised patients compared to usual care. Using the Bispectral Index to monitor and control depth of anaesthesia appear to reduce the incidence of postoperative delirium. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 39 studies with a total of 16 082 subjects, assessing 22 different interventions. 32 studies were conducted in patients undergoing surgery, the majority in orthopaedic settings. Multi-component interventions (individualised care, checklists, education/training, attention to sensory deprivation, nutrition, mobilisation etc.) reduced the incidence of delirium compared to usual care (RR 0.69, 95% CI 0.59 to 0.81; 7 studies; n=1950; moderate-quality evidence). Effect sizes were similar in medical and surgical settings. In the subgroup of patients with pre-existing dementia, the effect of multi-component interventions remains uncertain.

Bispectral Index (BIS)-guided anaesthesia reduced the incidence of delirium compared to BIS-blinded anaesthesia or clinical judgement (RR 0.71, 95% CI 0.60 to 0.85; 2 studies; n=2057; moderate quality evidence).

There is no clear evidence that cholinesterase inhibitors, melatonin, or melatonin agonists are effective in preventing delirium compared to placebo (RR 0.68, 95% CI, 0.17 to 2.62; two studies, 113 participants; very low-quality evidence).Three trials provide no clear evidence of an effect of antipsychotic medications as a group on the incidence of delirium. There was no evidence for effectiveness of a typical antipsychotic (haloperidol), however, delirium incidence was lower for patients treated with an atypical antipsychotic (olanzapine) compared to placebo.

Comment: The quality of evidence is downgraded by study quality (lack of blinding of participants and personal in all studies and lack of blinding of outcome assessors in 2 studies) and by heterogeneity in interventions.

    References

    • Siddiqi N, Stockdale R, Britton AM, Holmes J. Interventions for preventing delirium in hospitalised patients. Cochrane Database Syst Rev 2007 Apr 18;(2):CD005563 [Assessed as up-to-date: 4 December 2015]. [PubMed]

Primary/Secondary Keywords