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.authorAbraha, Iosief
dc.contributor.authorTrotta, Fabiana
dc.contributor.authorRimland, Joseph M.
dc.contributor.authorCruz-Jentoft, Alfonso
dc.contributor.authorLozano-Montoya, Isabel
dc.contributor.authorSoiza, Roy L.
dc.contributor.authorPierini, Valentina
dc.contributor.authorFulgheri, Paolo Dessi
dc.contributor.authorLattanzio, Fabrizia
dc.contributor.authorO'Mahony, Denis
dc.contributor.authorCherubini, Antonio
dc.contributor.funderEuropean Commission
dc.contributor.funderSeventh Framework Programme
dc.date.accessioned2016-02-17T10:07:57Z
dc.date.available2016-02-17T10:07:57Z
dc.date.issued2015-06-10
dc.description.abstractBackground: 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.sponsorshipEuropean Commission (Seventh Framework Program Grant Agreement No. 305930 (SENATOR))en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide0123090
dc.identifier.citationAbraha 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.doi10.1371/journal.pone.0123090
dc.identifier.issn1932-6203
dc.identifier.issued6en
dc.identifier.journaltitlePLOS ONEen
dc.identifier.urihttps://hdl.handle.net/10468/2306
dc.identifier.volume10en
dc.language.isoenen
dc.publisherPublic Library of Scienceen
dc.relation.projectinfo: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
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 crediteden
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectRandomized controlled trialen
dc.subjectHip-fracture patientsen
dc.subjectComprehensive geriatric assessmenten
dc.subjectFemoral neck fractureen
dc.subjectPostoperative deliriumen
dc.subjectElderly patientsen
dc.subjectMulticomponent interventionen
dc.subjectCardiac surgeryen
dc.subjectMultifactorial interventionen
dc.subjectHaloperidol prophylaxisen
dc.titleEfficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. The SENATOR project ONTOP seriesen
dc.typeArticle (peer-reviewed)en
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