Abraha Iosief, Trotta Fabiana, Rimland Joseph M, Cruz-Jentoft Alfonso, Lozano-Montoya Isabel, Soiza Roy L, Pierini Valentina, Dessì Fulgheri Paolo, Lattanzio Fabrizia, O'Mahony Denis, Cherubini Antonio
Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy.
Scientific Direction, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy.
PLoS One. 2015 Jun 10;10(6):e0123090. doi: 10.1371/journal.pone.0123090. eCollection 2015.
Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making.
We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95%CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium.
In older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium.
非药物干预（如多学科干预、音乐疗法、强光疗法、教育干预等）是可用于老年受试者的替代干预措施。已有大量关于老年患者谵妄预防和治疗的非药物干预综述，临床医生需要一份综合的、方法学合理的文件来辅助决策。
我们对关于老年患者非药物干预治疗或预防谵妄的比较研究的系统评价（SRs）进行了系统概述。检索了PubMed、Cochrane系统评价数据库、EMBASE、CINHAL和PsychINFO（2014年4月28日）以获取相关文章。使用AMSTAR评估SRs的质量。采用GRADE方法评估原始研究的质量。确定并比较不同研究中多成分干预的要素，以探索进行荟萃分析的可能性。使用随机效应模型估计风险比。24项包含了31项原始研究的SRs符合纳入标准。根据AMSTAR标准，12项综述质量中等，3项质量高。总体而言，多成分非药物干预显著降低了外科病房谵妄的发生率[2项随机对照试验（RCTs）：相对风险（RR）0.71，95%置信区间（CI）0.59至0.86，I² = 0%；（GRADE证据：中等）]以及内科病房谵妄的发生率[2项对照临床试验（CCTs）：RR 0.65，95%CI 0.49至0.86，I² = 0%；（GRADE证据：中等）]。没有证据支持非药物干预在低风险人群（即对照组谵妄发生率低）中预防谵妄的疗效[1项RCT：RR 1.75，95%CI 0.50至6.10（GRADE证据：极低）]。对于已发生谵妄的患者，现有证据不支持多成分非药物干预治疗谵妄的疗效。在单一成分干预中，只有工作人员教育、重新定向方案（GRADE证据：极低）和老年风险评估医学指南软件[风险比0.42，95%CI 0.35至0.52，（GRADE证据：中等）]在预防谵妄方面有效。
在老年患者中，多成分非药物干预以及一些单一成分干预在预防谵妄方面有效，但在治疗谵妄方面无效。
