Summary of findings 2. Multicomponent educational intervention compared to control for preventing delirium in older people in institutional long‐term care.
| Multicomponent educational intervention compared to control for preventing delirium in older people in institutional long‐term care | ||||||
| Patient or population: preventing delirium in older people in institutional long‐term care Setting: long‐term care institutions Intervention: multicomponent educational intervention Comparison: control | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with control | Risk with multicomponent educational intervention versus control | |||||
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Prevalence of delirium Assessed with: short‐CAM Follow‐up: period prevalence at 16 months postrandomisation (assessed over a 1‐month period) |
Study population | RR 0.57 (0.15 to 2.19) | 160a (1 RCT) | ⊕⊝⊝⊝ Very lowb,c,d | — | |
| 71 per 1000 | 40 per 1000 (11 to 155) | |||||
|
Incidence of delirium Assessed with: short‐CAM Follow‐up:16 months postrandomisation (assessed over a 1‐month period) |
Study population |
RR 0.62 (0.16 to 2.39) |
137e (1 RCT) |
⊕⊝⊝⊝ Very lowb,c,d | Rate data reported in paper: 4.9 (95% CI 0.7 to 15) per 100 resident‐months at risk in intervention homes and 7.9 (95% CI 1.4 to 22.0) per 100 resident‐months at risk in control homes. |
|
| 100 per 1000 |
62 per 1000 (16 to 239) |
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Severity of delirium Assessed with: DRS‐R‐98 Follow‐up: 16 months postrandomisation (assessed over a 1‐month period) |
N/A | N/A | — | N/A | N/A | DRS‐R‐98 completed for 12/13 short CAM positive residents. All rated as high severity (score >15.25) |
|
Mortality Assessed with: care home records Follow‐up: 10 months postrandomisation (recorded over a 6‐month period) |
Study population | RR 0.82 (0.50 to 1.34) | 215 (1 RCT) | ⊕⊕⊕⊝ Moderatec,d | — | |
| 250 per 1000 | 205 per 1000 (125 to 335) | |||||
|
Cognitive function Assessed with: 6‐CIT |
N/A | — | N/A | N/A | Baseline assessment only. | |
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Falls Assessed with: care home records |
N/A | N/A | — | N/A | N/A | Due to fall recording issues, falls were not analysed further following baseline. |
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Hospital admissions Assessed with: hospital episode statistics Follow‐up: 10 months postrandomisation (assessed over a 6‐month period) |
Study population | RR 0.67 (0.57 to 0.79) | 494f (1 RCT) | ⊕⊕⊕⊝ Moderated,f | — | |
| 642 per 1000 | 430 per 1000 (366 to 507) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). 6‐CIT: 6‐item Cognitive Impairment Test; CAM: Confusion Assessment Method; CI: confidence interval; DRS‐R‐98: Delirium Rating Scale, Revised; N/A: not applicable; RCT: randomised controlled trial; RR: risk ratio; Short‐CAM: Short Confusional Assessment Method. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aTotal number included in the analysis. bAssessed as high risk of methodological bias for blinding of participants and personnel. cDowngraded due to imprecision. dOne trial only so not possible to assess for consistency. eNumber of participants was number of resident‐months. Residents were assessed over a 1‐month period, not all residents completed assessments for the full month. fDowngraded due to indirectness. The hospital admissions data were based on a national methodology to quantify admissions from care homes, incorporating care‐home postcode combined with an age cut‐off. This meant older adults living in the same postcode area as a care home may have been included in the results.