Summary of findings 3. Single‐component medication monitoring and adjustment intervention versus control for preventing delirium in older people in institutional long‐term care.
| Single‐component medication monitoring and adjustment intervention versus control for preventing delirium in older people in institutional long‐term care | ||||||
| Patient or population: people at risk of delirium in institutional long‐term care Settings: long‐term care institutions Intervention: single‐component medication monitoring and adjustment intervention Comparison: control | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participant‐months (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with control | Risk with single‐component medication monitoring and adjustment intervention versus control | |||||
| Prevalence of delirium | — | — | — | — | — | Not measured |
|
Incidence of delirium NH‐CAM Follow‐up: mean 12 months |
Study population | HR 0.42 (0.34 to 0.51) | 7311 (1 study)a | ⊕⊕⊕⊝ Moderateb,c,d | — | |
| 104 per 1000 | 45 per 1000 (37 to 54) | |||||
| Severity of delirium | — | — | — | — | — | Not measured |
|
Mortality Follow‐up: mean 12 months |
Study population | HR 0.88 (0.66 to 1.17) | 9412 (1 study)a | ⊕⊕⊕⊝ Moderatec,d,e | — | |
| 25 per 1000 | 22 per 1000 (17 to 29) | |||||
| Cognitive function | — | — | — | — | — | Not measured |
|
Falls Fall events Follow‐up: mean 12 months |
Study population | RR 1.03 (0.92 to 1.15) | 2275 (1 study)a | ⊕⊕⊝⊝ Lowb,c,d | — | |
| 523 per 1000 | 539 per 1000 (481 to 601) | |||||
|
Hospital admissions Follow‐up: mean 12 months |
Study population | HR 0.89 (0.72 to 1.10) | 7599 (1 study)a | ⊕⊕⊕⊝ Moderatec,d,e | — | |
| 55 per 1000 | 49 per 1000 (40 to 60) | |||||
| *Therisk 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). CI: confidence interval; HR: hazard ratio; NH‐CAM: Nursing Home Confusional Assessment Method; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate. | ||||||
aNumber of participant months is defined as the number of days from first assessment to the first outcome occurrence, the last date in the nursing home, death date or 31 December 2004. bAssessed as high risk of methodological bias for blinding of participants and personnel. cOnly one trial, therefore, unable to assess consistency. dLarge effect size observed but only one trial, therefore, not eligible for upgrade. eDowngraded due to imprecision.