Effectiveness of Non Pharmacological Interventions in Preventing Delirium Among Older Adults

An overview of systematic reviews about non pharmacological interventions in preventing and treating delirium among older people found that multicomponent interventions are effective in reducing delirium incidence and improving various health outcomes, while single component interventions have limited effectiveness in treating delirium. The results of the overview were published in the International Journal of Nursing Studies.

The prevalence of delirium in the older population has increased due to the risk factor of advanced age which can lead to longer hospital stays, cognitive decline, and increased risks of complications and mortality. To prevent delirium, non-pharmacological interventions are recommended by the National Institute for Health and Care Excellence, as they are preferred over pharmacological methods. Several systematic reviews and meta-analyses have been conducted to examine the impact of non pharmacological interventions. However, the results have been inconsistent, and the quality of the studies varied significantly, making it difficult to come to solid conclusions based on the available.

Researchers searched databases including Medline, Cochrane Library, EMBASE, CINAHL, PsycINFO, JBI EBP Database, China's SinoMed, CNKI, and Wangfang for studies up until December 2, 2022. Two reviewers conducted the process of selecting studies, assessing their quality, and extracting data separately. The AMSTAR 2 tool was utilized to evaluate the methodological quality of eligible reviews. The findings were presented in a narrative synthesis format, categorizing interventions into multicomponent and single-component interventions.

Twenty four systematic reviews were included, 4 of which were considered high quality. The most widely used non pharmacological approach was multicomponent interventions, which proved effective in reducing delirium incidence by 27% to 54%. Multicomponent interventions also demonstrated reductions in falls and pressure ulcers and showed potential for reducing length of stay and improving cognitive function. Single component interventions such as physical training, geriatric risk assessment, and reorientation protocol also showed positive effects in preventing delirium. However, the effectiveness of non pharmacological interventions for treating delirium was limited, with multicomponent methods having inconsistent impacts on the duration and severity of delirium, while single component methods showed no significant impact.
There is evidence to support the success of non pharmacological interventions in decreasing the occurrence of delirium and enhancing overall health outcomes in older patients. Further evidence is required to verify the impact on the length and severity of delirium.

“In clinical practice, it is crucial to evaluate the risk of delirium in older patients at an early stage and implement validated multicomponent interventions to prevent the onset of delirium,” said researchers. 

Reference:

Zhao Q, Liu S, Zhao H, et all. Non-pharmacological interventions to prevent and treat delirium in older people: An overview of systematic reviews. Intnl Jour of Nursing Studies. Published August 9, 2023, online ahead of print. doi.org/10.1016/j.ijnurstu.2023.104584