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Where should patients with or at risk of delirium be treated in an acute care system? Comparing the rates of delirium in patients receiving usual care versus alternative care : a systematic review and meta‐analysis
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Ekeozor, Chinenye Ukwuoma, Jeyaruban, Darshana and Lasserson, Daniel (2020) Where should patients with or at risk of delirium be treated in an acute care system? Comparing the rates of delirium in patients receiving usual care versus alternative care : a systematic review and meta‐analysis. International Journal of Clinical Practice . e13859. doi:10.1111/ijcp.13859 (In Press)
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WRAP-where-should-patients-with-risk-delirium-treated-acute-care-system-Lasserson-2020 .pdf - Accepted Version Embargoed item. Restricted access to Repository staff only until 25 November 2022. Contact author directly, specifying your specific needs. - Requires a PDF viewer. Download (2166Kb) |
Official URL: http://dx.doi.org/10.1111/ijcp.13859
Abstract
Background:
Delirium is an acute condition that occurs in hospitalised patients and leads to poor patient outcomes that can last long term. Therefore, the importance of prevention is undeniable and adopting new models of care for at risk patients should be prioritised.
Objectives:
This systematic review and meta‐analysis will assess the effectiveness of different interventions designed to prevent or manage delirium in acutely unwell hospitalised patients.
Methods:
MEDLINE, EMBASE, PsychINFO, OpenGrey, Web of Science and reference lists of journals were searched. Eligible studies reported on incidence or duration of delirium, used a validated delirium diagnostic tool, and compared an intervention to either a control or another intervention group. Meta‐analyses were conducted, and GRADE pro software was used to assess the certainty of evidence. This review is registered on PROSPERO.
Results:
A total of 59 studies were included and 33 were eligible for meta‐analysis. Delirium incidence was most significantly reduced by non‐pharmacological multicomponent interventions compared to usual care, with pooled risk ratios of 0.57 (95% CI: 0.44 to 0.73, ten randomised controlled trials) and 0.47 (95% CI: 0.35 to 0.64, six observational studies). Single component interventions did not significantly reduce delirium incidence compared to usual care in seven randomised trials (risk ratio= 0.92, 95% CI: 0.81 to 1.04). The most effective single component intervention in reducing delirium incidence, was a hospital‐at‐home intervention (risk ratio = 0.29, 95% CI: 0.09 to 0.87).
Conclusions:
Non‐pharmacological multicomponent interventions are effective in preventing delirium, however the same cannot be said for other interventions due to uncertain results. There is some evidence that providing multicomponent interventions in patients’ homes is more effective than a hospital setting. Therefore, researching the benefits of hospital‐at‐home interventions in delirium prevention is recommended.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RT Nursing |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Delirium , Delirium -- Treatment, Delirium -- Patients -- Care, Delirium -- Prevention, Intensive care nursing | |||||||||
| Journal or Publication Title: | International Journal of Clinical Practice | |||||||||
| Publisher: | Wiley-Blackwell Publishing, Inc | |||||||||
| ISSN: | 1368-5031 | |||||||||
| Official Date: | 25 November 2020 | |||||||||
| Dates: |
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| Date of first compliant deposit: | 1 December 2020 | |||||||||
| Article Number: | e13859 | |||||||||
| DOI: | 10.1111/ijcp.13859 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | In Press | |||||||||
| Publisher Statement: | This is the peer reviewed version of the following article: Ekeozor, C.U., Jeyaruban, D. and Lasserson, D. (2020), Where should patients with or at risk of delirium be treated in an acute care system? Comparing the rates of delirium in patients receiving usual care versus alternative care: a systematic review and meta‐analysis.. International Journal of Clinical Practice. Accepted Author Manuscript e13859. https://doi.org/10.1111/ijcp.13859, which has been published in final form at https://doi.org/10.1111/ijcp.13859. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. | |||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||
| RIOXX Funder/Project Grant: |
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