Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. The SENATOR project ONTOP series

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dc.contributor.author Abraha, Iosief
dc.contributor.author Trotta, Fabiana
dc.contributor.author Rimland, Joseph M.
dc.contributor.author Cruz-Jentoft, Alfonso
dc.contributor.author Lozano-Montoya, Isabel
dc.contributor.author Soiza, Roy L.
dc.contributor.author Pierini, Valentina
dc.contributor.author Fulgheri, Paolo Dessi
dc.contributor.author Lattanzio, Fabrizia
dc.contributor.author O'Mahony, Denis
dc.contributor.author Cherubini, Antonio
dc.date.accessioned 2016-02-17T10:07:57Z
dc.date.available 2016-02-17T10:07:57Z
dc.date.issued 2015-06-10
dc.identifier.citation Abraha I, Trotta F, Rimland JM, Cruz-Jentoft A, Lozano-Montoya I, Soiza RL, et al. (2015) Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series. PLoS ONE 10(6): e0123090. doi:10.1371/journal.pone.0123090
dc.identifier.volume 10 en
dc.identifier.issued 6 en
dc.identifier.issn 1932-6203
dc.identifier.uri http://hdl.handle.net/10468/2306
dc.identifier.doi 10.1371/journal.pone.0123090
dc.description.abstract Background: Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making. Methods and Findings: We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I-2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95% CI 0.49 to 0.86, I-2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95% CI 0.50 to 6.10 ( GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95% CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium. Conclusions: In older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium. en
dc.description.sponsorship European Commission (Seventh Framework Program Grant Agreement No. 305930 (SENATOR)) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Public Library of Science en
dc.rights © 2015 Abraha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited en
dc.rights.uri http://creativecommons.org/licenses/by/4.0/ en
dc.subject Randomized controlled trial en
dc.subject Hip-fracture patients en
dc.subject Comprehensive geriatric assessment en
dc.subject Femoral neck fracture en
dc.subject Postoperative delirium en
dc.subject Elderly patients en
dc.subject Multicomponent intervention en
dc.subject Cardiac surgery en
dc.subject Multifactorial intervention en
dc.subject Haloperidol prophylaxis en
dc.title Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. The SENATOR project ONTOP series en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Denis O'Mahony, Department of Medicine, University College Cork, Cork, Ireland. +353-21-490-3000 Email:denis.omahony@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.internal.rssid 372343941
dc.internal.rssid 372343941
dc.internal.rssid 372343941
dc.internal.wokid WOS:000355979500004
dc.contributor.funder European Commission
dc.contributor.funder Seventh Framework Programme
dc.description.status Peer reviewed en
dc.identifier.journaltitle PLOS ONE en
dc.internal.IRISemailaddress denis.omahony@ucc.ie en
dc.identifier.articleid e0123090
dc.relation.project info:eu-repo/grantAgreement/EC/FP7::SP1::HEALTH/305930/EU/Development and clinical trials of a new Software ENgine for the Assessment & Optimization of drug and non-drug Therapy in Older peRsons/SENATOR


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© 2015 Abraha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Except where otherwise noted, this item's license is described as © 2015 Abraha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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