Multicomponent Interventions for the Prevention of Delirium in Hospitalized Older People: A Meta-Analysis

Abstract

Objectives: To comprehensively assess the effects of multicomponent interventions for prevention of delirium in hospitalized older people.

Design: Systematic review with meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods.

Participants: All randomized controlled trials were included. Included studies were conducted in hospitalized older people (aged ≥65 years).

Measurements: The electronic databases MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were consulted (search date: 2015 to March 2019). Predefined criteria were used to determine inclusion of studies and to assess their methodologic quality.

Results: From 1,250 records identified, 10 randomized controlled trials were included (n = 2,850: 1355 medical patients, 1,243 surgical, and 160 intensive care unit). The multicomponent interventions, compared with usual care, reduced the incidence of delirium (risk ratio (RR) = 0.62; 95% confidence interval (CI) = 0.54-0.72; I² = 0%; k = 10; n = 2,758), duration of delirium (RR = -1.18; 95% CI = -1.95 to -0.40; I² = 45%; k = 6; n = 276), severity of delirium (standard mean difference = -0.98; 95% CI = -1.46 to -0.49; I² = 0%; k = 3; n = 82), and pressure ulcers (RR = 0.48; 95% CI = 0.26-0.88; I² = 0%; k = 2; n = 457).

Conclusions: This meta-analysis suggests that multicomponent interventions to prevent delirium are effective in decreasing its incidence, duration, and severity; as well as the incidence of pressure ulcers in hospitalized older people. Therefore, multicomponent interventions hold great promise to impact in the most important and prevalent conditions affecting fragile older people during hospitalization.

Keywords: delirium; hospitalization; meta-analysis; multicomponent; older people; prevention.