Skip to main content
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1996 Nov 1;155(9):1263–1268.

Effectiveness of interventions to prevent delirium in hospitalized patients: a systematic review.

M G Cole 1, F Primeau 1, J McCusker 1
PMCID: PMC1335067  PMID: 8911292

Abstract

OBJECTIVE: To determine the effectiveness of interventions to prevent delirium in hospitalized patients. DATA SOURCES: Two databases, MEDLINE and CINAHL, were searched for relevant articles published from January 1966 to May 1995 and from January 1982 to May 1995 respectively. The bibliographies of identified articles were searched for additional references. STUDY SELECTION: Ten articles met the following three inclusion criteria: (a) original research article, (b) published in English or French and (c) controlled trial (nonrandomized or randomized) of an intervention to prevent delirium in hospitalized patients. The validity of the studies was independently assessed according to the criteria for intervention studies proposed by the Evidence-Based medicine Working Group. DATA EXTRACTION: Information about study design, patient population, sample size, diagnostic criteria, interventions and results was systematically abstracted from each report. Absolute risk reduction (ARR) for delirium was calculated for each study. DATA SYNTHESIS: Eight trials involved surgical patients and two involved elderly medical patients; most of the studies had serious methodological limitations. Among the surgical patients the ARRs ranged from -13% to 81% and were not related to the type or timing of the intervention, or to the personnel involved. Among the elderly medical patients the ARRs ranged from -3% to 3%. CONCLUSION: Interventions to prevent delirium among surgical patients may be modestly effective, but further trials are necessary.

Full text

PDF
1266

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beresin E. V. Delirium in the elderly. J Geriatr Psychiatry Neurol. 1988 Jul-Sep;1(3):127–143. doi: 10.1177/089198878800100302. [DOI] [PubMed] [Google Scholar]
  2. Budd S., Brown W. Effect of a reorientation technique on postcardiotomy delirium. Nurs Res. 1974 Jul-Aug;23(4):341–348. [PubMed] [Google Scholar]
  3. Chatham M. A. The effect of family involvement on patients' manifestations of postcardiotomy psychosis. Heart Lung. 1978 Nov-Dec;7(6):995–999. [PubMed] [Google Scholar]
  4. Cole M. G., Primeau F. J., Bailey R. F., Bonnycastle M. J., Masciarelli F., Engelsmann F., Pepin M. J., Ducic D. Systematic intervention for elderly inpatients with delirium: a randomized trial. CMAJ. 1994 Oct 1;151(7):965–970. [PMC free article] [PubMed] [Google Scholar]
  5. Francis J. Delirium in older patients. J Am Geriatr Soc. 1992 Aug;40(8):829–838. doi: 10.1111/j.1532-5415.1992.tb01859.x. [DOI] [PubMed] [Google Scholar]
  6. Gustafson Y., Brännström B., Berggren D., Ragnarsson J. I., Sigaard J., Bucht G., Reiz S., Norberg A., Winblad B. A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. J Am Geriatr Soc. 1991 Jul;39(7):655–662. doi: 10.1111/j.1532-5415.1991.tb03618.x. [DOI] [PubMed] [Google Scholar]
  7. Guyatt G. H., Sackett D. L., Cook D. J. Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA. 1994 Jan 5;271(1):59–63. doi: 10.1001/jama.271.1.59. [DOI] [PubMed] [Google Scholar]
  8. Inouye S. K. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med. 1994 Sep;97(3):278–288. doi: 10.1016/0002-9343(94)90011-6. [DOI] [PubMed] [Google Scholar]
  9. Layne O. L., Jr, Yudofsky S. C. Postoperative psychosis in cardiotomy patients. The role of organic and psychiatric factors. N Engl J Med. 1971 Mar 11;284(10):518–520. doi: 10.1056/NEJM197103112841003. [DOI] [PubMed] [Google Scholar]
  10. Lazarus H. R., Hagens J. H. Prevention of psychosis following open-heart surgery. Am J Psychiatry. 1968 Mar;124(9):1190–1195. doi: 10.1176/ajp.124.9.1190. [DOI] [PubMed] [Google Scholar]
  11. Levkoff S., Cleary P., Liptzin B., Evans D. A. Epidemiology of delirium: an overview of research issues and findings. Int Psychogeriatr. 1991 Winter;3(2):149–167. doi: 10.1017/s1041610291000625. [DOI] [PubMed] [Google Scholar]
  12. Nagley S. J. Predicting and preventing confusion in your patients. J Gerontol Nurs. 1986 Mar;12(3):27–31. doi: 10.3928/0098-9134-19860301-09. [DOI] [PubMed] [Google Scholar]
  13. Owens J. F., Hutelmyer C. M. The effect of preoperative intervention on delirium in cardiac surgical patients. Nurs Res. 1982 Jan-Feb;31(1):60–62. [PubMed] [Google Scholar]
  14. Oxman A. D., Cook D. J., Guyatt G. H. Users' guides to the medical literature. VI. How to use an overview. Evidence-Based Medicine Working Group. JAMA. 1994 Nov 2;272(17):1367–1371. doi: 10.1001/jama.272.17.1367. [DOI] [PubMed] [Google Scholar]
  15. Rockwood K., Cosway S., Stolee P., Kydd D., Carver D., Jarrett P., O'Brien B. Increasing the recognition of delirium in elderly patients. J Am Geriatr Soc. 1994 Mar;42(3):252–256. doi: 10.1111/j.1532-5415.1994.tb01747.x. [DOI] [PubMed] [Google Scholar]
  16. Rockwood K. The occurrence and duration of symptoms in elderly patients with delirium. J Gerontol. 1993 Jul;48(4):M162–M166. doi: 10.1093/geronj/48.4.m162. [DOI] [PubMed] [Google Scholar]
  17. Schindler B. A., Shook J., Schwartz G. M. Beneficial effects of psychiatric intervention on recovery after coronary artery bypass graft surgery. Gen Hosp Psychiatry. 1989 Sep;11(5):358–364. doi: 10.1016/0163-8343(89)90124-2. [DOI] [PubMed] [Google Scholar]
  18. Trzepacz P. T. A review of delirium assessment instruments. Gen Hosp Psychiatry. 1994 Nov;16(6):397–405. doi: 10.1016/0163-8343(94)90115-5. [DOI] [PubMed] [Google Scholar]
  19. Wanich C. K., Sullivan-Marx E. M., Gottlieb G. L., Johnson J. C. Functional status outcomes of a nursing intervention in hospitalized elderly. Image J Nurs Sch. 1992 Fall;24(3):201–207. doi: 10.1111/j.1547-5069.1992.tb00719.x. [DOI] [PubMed] [Google Scholar]
  20. Williams M. A., Campbell E. B., Raynor W. J., Mlynarczyk S. M., Ward S. E. Reducing acute confusional states in elderly patients with hip fractures. Res Nurs Health. 1985 Dec;8(4):329–337. doi: 10.1002/nur.4770080405. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES