This meta-analysis of 14 studies involving multi-component non-pharmacologic interventions is published this week in JAMA Internal Medicine.
"Delirium
is a major problem at many hospitals and preventing its downstream
consequences, including falls, is a priority,” said Tammy Hshieh, MD, of
BWH’s
Division of Aging and the Aging Brain Center in Hebrew SeniorLife’s
Institute for Aging Research. “Delirium can be the source of anxiety for
many patients
and their families and often they wish that there was a pill that
would make the patient’s symptoms go away. Our study demonstrates that
there are
effective strategies for preventing delirium and treating patients
that don’t rely on medications.”
Researchers analyzed studies that had examined six interventions that targeted delirium risk factors, guided by principles derived from the original delirium prevention study, the Hospital Elder Life Program (HELP). Interventions included strategies to improve a person’s nutrition and hydration and to ensure uninterrupted sleep; daily exercise and therapeutic activities to improve cognition; and “re-orientation” or telling patients where they are and the date and time every day. The studies were conducted at 12 hospital sites from all over the world.
“These preventive approaches provide evidence-based models to improve processes of care for older hospitalized persons. The fact that these approaches are so effective for prevention of delirium, falls and institutionalization provides strong support for their importance in the setting of accountable, cost-effective care. We hope this study will bring to attention these important models for hospital administrators and policymakers,” said Sharon K. Inouye, MD, MPH, director of the Aging Brain Center at the Institute for Aging Research at Hebrew SeniorLife and the senior author on the paper.
The researchers found that older patients who received non-medication based interventions were at decreased risk of both delirium and falls, and found trends toward decreased length of hospital stay and institutionalization. Based on their results, they estimated that each year, approximately one million cases of delirium could be prevented using non-medication based interventions, resulting in a Medicare cost savings of $10 billion per year.
Delirium is a disorder with a constellation and range of symptoms – patients can exhibit agitation and confusion or they may be non-responsive. It is estimated that 29 to 64 percent of hospitalized elderly patients suffer from delirium, although it is likely under-diagnosed.
“Delirium is sometimes difficult to recognize but given its complications, it deserves more national and international attention,” said Hshieh. “If we can prevent delirium, we can do a lot of good for patients in the long run. It’s important for both families and healthcare providers to be aware of these beneficial non-medical strategies.”
In addition to Hshieh and Inouye, study coauthors include Jirong Yue, MD of West China Hospital, Sichuan University; Esther Oh, MD of Johns Hopkins School of Medicine; Sarah Dowal, MSW, MPH and Thomas Travison, PhD of the Aging Brain Center, Hebrew SeniorLife.
This study was supported in part by Grant K07AG041835 from the National Institute on Aging. Dr. Hshieh is supported by T32 Training Grant (AG000158) from the National Institute on Aging. Dr. Inouye holds the Milton and Shirley F. Levy Family Chair. The funding sources had no role in the design, conduct or reporting of this study.