U.O.C. Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, Ancona, Italy.
Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK.
Eur Geriatr Med. 2020 Feb;11(1):71-81. doi: 10.1007/s41999-019-00260-7. Epub 2020 Jan 2.
Delirium is a geriatric syndrome often occurring in hospitalized older patients. Since there is no established treatment for delirium, it is important to identify patients at high risk to develop it, to implement preventive interventions. As yet, there is no conclusive evidence that different drugs classes are effective in preventing delirium; whereas they have potentially severe adverse effects. The non-pharmacological interventions to prevent delirium are quite diverse, ranging from single-component interventions to complex multi-component interventions that deploy simultaneous care for different risk factors. The aim of this review was to summarize the evidence concerning the efficacy of non-pharmacological interventions in delirium prevention in older adults.
Extensive PubMed search using the following keywords with different combinations: delirium (with or without "prevention") AND non-pharmacological; interventions; multi-component. The reference lists of retrieved articles and, most of all, systematic reviews and meta-analysis, were screened for additional pertinent studies.
The evidence for non-pharmacological, multi-component interventions is sufficiently robust for clinical practice recommendations to be formulated. However, no conclusive effects have been demonstrated on outcomes more distal to delirium occurrence and for single-component interventions.
The majority of studies that investigated non-pharmacological prevention of delirium were designed as explanatory studies aimed at demonstrating the efficacy of the intervention. In the future, pragmatic studies should be conducted, in which the aim is to investigate effectiveness in usual clinical practice.
谵妄是一种常见于住院老年患者的老年综合征。由于目前尚无针对谵妄的既定治疗方法，因此识别有发生谵妄风险的患者并实施预防干预措施非常重要。到目前为止，尚无确凿证据表明不同类别的药物可有效预防谵妄；而这些药物具有潜在的严重不良反应。预防谵妄的非药物干预措施相当多样，从单一成分的干预措施到同时针对不同危险因素进行护理的复杂多成分干预措施都有。本综述的目的是总结关于非药物干预措施预防老年人谵妄的疗效的证据。
使用以下关键词的不同组合进行广泛的 PubMed 搜索：谵妄（带或不带“预防”）和非药物；干预；多成分。检索文章的参考文献列表，尤其是系统评价和荟萃分析，都被筛选以寻找其他相关研究。
有足够的证据支持非药物、多成分干预措施可用于临床实践推荐。然而，对于单一成分的干预措施，尚未证明对谵妄发生以外的结果有明确的效果。
大多数研究都旨在证明干预措施的有效性，因此设计为解释性研究来调查非药物预防谵妄。未来，应该进行实用性研究，以调查在常规临床实践中的效果。
