[Evidence-based non-pharmacological delirium prevention on general wards - A systematic literature review]

Armin Hauß; Max Zilezinski; Manuela Bergjan

doi:10.1016/j.zefq.2020.11.007

[Evidence-based non-pharmacological delirium prevention on general wards - A systematic literature review]

Z Evid Fortbild Qual Gesundhwes. 2021 Feb:160:1-10. doi: 10.1016/j.zefq.2020.11.007. Epub 2021 Jan 16.

[Article in German]

Authors

Armin Hauß¹, Max Zilezinski², Manuela Bergjan³

Affiliations

¹ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Geschäftsbereich Pflegedirektion - Pflegewissenschaft, Core Team III Delirmanagement und Demenzpflege, Berlin, Deutschland. Electronic address: armin.hauss@charite.de.
² Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Geschäftsbereich Pflegedirektion - Pflegewissenschaft, Core Team III Delirmanagement und Demenzpflege, Berlin, Deutschland.
³ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Geschäftsbereich Pflegedirektion - Pflegewissenschaft, Berlin, Deutschland.

PMID: 33461904
DOI: 10.1016/j.zefq.2020.11.007

Abstract

Background: Delirium is a disturbance of attention and consciousness and a serious complication, especially in older hospitalized patients. For non-pharmacological delirium prevention, mainly so-called multicomponent programmes are described, which have to be adapted to the individual risk profile. The aim of this systematic review was to summarize the current status of the available evidence on non-pharmacological delirium prevention in general wards.

Method: The databases MEDLINE via Pubmed, CINAHL, EMBASE, PsycINFO and Cochrane Library were searched for the period from 1990 to November 2018; the methodological quality of the systematic reviews and meta-analyses was evaluated with AMSTAR 2. In order to reflect the broad spectrum of delirium prevention, international guidelines were included in the systematic review.

Results: A total of 77 titles were read in full text, nine reviews and six guidelines were included in the analysis. Eight meta-analyses demonstrated that non-pharmacological multicomponent programmes for delirium prevention reduce the incidence of delirium compared to standard care (RR 0.65 to 0.73; OR 0.47 to 0.64, with varying methodological quality). The effect size was similar in the surgical (RR 0.63 to 0.71; OR 0.64) and non-surgical (RR 0.65 to 0.73; OR 0.47) general ward setting. The multicomponent programmes for delirium prevention each consisted of a different number of interventions. In addition to twelve person-related interventions, e. g. promotion of orientation, mobility, day-night rhythm, environmental adjustments and staff training programmes, were considered.

Conclusion: Non-pharmacological multicomponent programmes for the prevention of delirium in general wards effectively reduce the incidence of delirium and must be adapted to the individual risk factors of each patient.

Keywords: Delir; Delirium; Interventionen; Interventions; Multicomponent; Multikomponenten; Nicht-pharmakologischen; Non-pharmacological; Prevention; Prävention.

Publication types

Review
Systematic Review

MeSH terms

Aged
Delirium* / prevention & control
Germany
Humans
Incidence
Patients' Rooms*