Martinez Felipe, Tobar Catalina, Hill Nathan
Centro de Investigaciones Biomedicas, Universidad de Valparaiso, Valparaiso, Chile Departamento de Salud Publica, Universidad de Valparaiso, Valparaiso, Chile.
Departamento de Medicina Interna, Universidad de Valparaiso, Valparaiso, Chile Escuela de Medicina, Universidad de Valparaiso, Valparaiso, Chile.
Age Ageing. 2015 Mar;44(2):196-204. doi: 10.1093/ageing/afu173. Epub 2014 Nov 25.
Delirium is a complex neuropsychiatric syndrome that is common among elderly inpatients. It has been associated with increased mortality, longer hospital stays, cognitive and functional decline and increased institutionalisation rates. Multicomponent interventions, a series of non-pharmacological strategies frequently handled by nursing staff, might be useful for prevention.
To assess the efficacy of multicomponent interventions in preventing incident delirium in the elderly.
A systematic review of randomised trials was undertaken. Two independent reviewers performed iterative literature searches in seven databases without language restrictions. Grey literature repositories were considered as well. The quality of included trials was assessed by using the criteria established by the Cochrane Collaboration. When possible, data were synthesised into a meta-analysis. Heterogeneity was assessed using the χ2 and I2 tests.
A total of 21,788 citations were screened, and seven studies of diverse quality were included in the review, comprising 1,691 participants. Multicomponent interventions significantly reduced incident delirium (relative risk [RR] 0.73, 95% confidence interval [CI] 0.63-0.85, P<0.001) and accidental falls during the hospitalisation (RR 0.39, 95% CI 0.21, 0.72, P=0.003), without evidence of differential effectiveness according to ward type or dementia rates. Non-significant reductions in delirium duration, hospital stay and mortality were found as well.
Multicomponent interventions are effective in preventing incident delirium among elderly inpatients. Effects seemed to be stable among different settings. Due to the limited amount of data, potential benefits in survival need to be confirmed in further studies. Future research should be aimed at contrasting different multicomponent programmes to select the most useful interventions.
谵妄是一种复杂的神经精神综合征，在老年住院患者中很常见。它与死亡率增加、住院时间延长、认知和功能衰退以及机构化率上升有关。多组分干预措施是护理人员经常采用的一系列非药物策略，可能有助于预防谵妄。
评估多组分干预措施在预防老年人发生谵妄方面的疗效。
对随机试验进行系统评价。两名独立的评价者在七个无语言限制的数据库中进行了迭代文献检索。还考虑了灰色文献库。采用Cochrane协作网制定的标准评估纳入试验的质量。尽可能将数据合并进行荟萃分析。使用χ2检验和I2检验评估异质性。
共筛选了21788条引文，7项质量各异的研究纳入综述，包括1691名参与者。多组分干预措施显著降低了住院期间谵妄的发生率（相对危险度[RR]0.73，95%置信区间[CI]0.63 - 0.85，P<0.001）以及意外跌倒的发生率（RR 0.39，95%CI 0.21，0.72，P = 0.003），没有证据表明根据病房类型或痴呆率存在效果差异。谵妄持续时间、住院时间和死亡率也有非显著降低。
多组分干预措施在预防老年住院患者发生谵妄方面有效。不同环境下效果似乎稳定。由于数据量有限，生存方面的潜在益处需要在进一步研究中得到证实。未来的研究应旨在对比不同的多组分方案以选择最有效的干预措施。
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