Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel.
Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel.
Int J Geriatr Psychiatry. 2017 May;32(5):492-508. doi: 10.1002/gps.4685. Epub 2017 Feb 26.
Agitation and delirium frequently occur in cognitively impaired older people. We conducted a systematic review with narrative synthesis of the literature aiming to assess effectiveness of complementary and alternative medicine (CAM) modalities to address these conditions.
Following preliminary search, we included 40 original researches on CAM treatment of delirium and agitation in older persons. Then, the quality of these studies was assessed using the Downs and Black Checklist and Quality Assessment Tool for Studies with Diverse Designs, and the effect sizes were calculated. We subsequently conducted a narrative synthesis of the main findings, including theory development, preliminary synthesis, exploration of relationships within and between studies, and assessment of synthesis robustness.
Forty articles that met the inclusion criteria were analyzed. Sixteen of these were randomized controlled trials. One article specifically addressed CAM treatment of delirium in patients without dementia, and the remaining 39 articles described treatments of agitated older persons with dementia. Thirty-five of the 40 included studies suggested that the investigated CAM therapies may ameliorate the severity of agitation and delirium. The physiological surrogates of agitation assessed in these studies included cortisol level, chromogranin A level, and heart rate variability. Very few of the studies systematically assessed safety issues, although no major adverse effects were reported.
Overall, the systematic review of the literature suggests that several CAM modalities are potentially beneficial in the treatment of agitation and delirium among older persons. We suggest that promising CAM modalities should be further explored through large-scale randomized controlled trials in different clinical settings. Copyright © 2017 John Wiley & Sons, Ltd.
认知障碍的老年人常发生激越和谵妄。我们对旨在评估补充和替代医学（CAM）治疗这些疾病的效果的文献进行了系统评价和叙述性综合。
在初步检索后，我们纳入了 40 项关于老年人谵妄和激越的 CAM 治疗的原始研究。然后，我们使用 Downs 和 Black 清单和用于不同设计研究的质量评估工具评估这些研究的质量，并计算效应量。随后，我们对主要发现进行了叙述性综合，包括理论发展、初步综合、研究内和研究间关系的探索以及综合稳健性的评估。
分析了符合纳入标准的 40 篇文章。其中 16 篇为随机对照试验。有 1 篇文章专门针对无痴呆症的谵妄患者的 CAM 治疗，其余 39 篇文章描述了痴呆症激越老年患者的治疗。在纳入的 40 项研究中，有 35 项研究表明，所研究的 CAM 疗法可能改善激越和谵妄的严重程度。这些研究中评估的激越的生理替代指标包括皮质醇水平、嗜铬粒蛋白 A 水平和心率变异性。尽管没有报告重大不良反应，但很少有研究系统地评估安全性问题。
总的来说，对文献的系统评价表明，几种 CAM 疗法在治疗老年人激越和谵妄方面可能是有益的。我们建议，应通过不同临床环境中的大规模随机对照试验进一步探索有前途的 CAM 疗法。版权所有 © 2017 约翰威立父子公司
