Elderly delirium patients improve without drugs,
Improvement in cognitive function, less falls for
older hospital patients result from practical interventions
2, 2015 – Prescription drugs and programs with multiple components are
not necessary to reduce delirium and prevent falls in hospitalized older
patents, according to an article published online by JAMA Internal
Delirium is a confused state that is marked by
inattention and global cognitive dysfunction (impaired memory and
Delirium is common among hospitalized older
patients and the condition increases the risk of falls, functional
decline, dementia, prolonged hospital stays and institutionalization.
The Hospital Elder Life Program (HELP) is the
original evidence-based approach to target delirium risk factors and it
includes practical interventions such as reorientation, early
mobilization, therapeutic activities, hydration, nutrition, strategies
to improve sleep, and vision and hearing aids, according to background
in the study.
Tammy T. Hshieh, M.D., of Brigham and Women’s
Hospital, Boston, and coauthors reviewed available medical literature
and evaluated the evidence on multicomponent nonpharmacological delirium
interventions. Their meta-analysis included 14 articles that involved
4,267 patients (average age nearly 80 years) at 12 sites (acute medical
and surgical wards).
The authors found that, overall, 11 studies showed
significant reductions in the incidence of delirium and four randomized
or matched clinical trials reduced delirium by 44 percent.
The rate of falls decreased among intervention
patients in four studies, and in two randomized or matched trials the
rate of falls was reduced by 64 percent.
Length of hospital stay and institutionalization
also trended toward decreases in intervention groups but the difference
was not statistically significant, which the authors explained was not
surprising given the multiple complex influences on these outcomes.
“In conclusion, this meta-analysis suggests that
multicomponent nonpharmacological interventions are effective in
decreasing delirium incidence and preventing falls, potentially saving
more than $16 billion annually in the United States alone,” the author’s
“Therefore, these strategies hold great promise to
influence two of the most important and prevalent conditions affecting
seniors during hospitalization. Our systematic review and meta-analysis
demonstrate that these interventions decrease the substantial health
care and societal burden of delirium incidence and falls, improving
quality of life for these patients and their families.”
This study was supported in part by a grant from
the National Institute on Aging.
Commentary: Delirium and the ‘Know-Do’ Gap in
Acute Care for Older Patients
“Numerous components of these interventions may
simply seem too simple to question that they are not being done already,
writes S. Ryan Greysen, M.D., M.H.S., M.A., of the University of
California, San Francisco, in an accompanying commentary.
“These include frequent orientation of patients to
time, place and situation; early mobilization; attention to hearing and
visual deficits and aids as appropriate; preservation of sleep-wake
cycles; and adequate hydration. Indeed, it is quite likely that some of
these interventions are occurring some of the time at many, if not most,
hospitals, but the key to their effectiveness may well lie in the
consistency of their application.”
“Changing practice in the acute care setting is
never easy and is often fraught with great uncertainty about risks and
benefits to patients and the system. However, with respect to delirium
prevention, the results by Hshieh et al suggest that it may no longer be
a matter of evidence or knowing what to do. It may now be a matter of
convincing hospitals and health care professionals to just do it,”
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