Canarian Foundation Institute of Health Research of Canary Islands (FIISC), Santa Cruz de Tenerife, Spain.
Health Services and Chronic Diseases Research Network (REDISSEC), Santa Cruz de Tenerife, Spain.
J Am Geriatr Soc. 2020 Dec;68(12):2947-2954. doi: 10.1111/jgs.16768. Epub 2020 Sep 9.
To comprehensively assess the effects of multicomponent interventions for prevention of delirium in hospitalized older people.
Systematic review with meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods.
All randomized controlled trials were included. Included studies were conducted in hospitalized older people (aged ≥65 years).
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.
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; I = 0%; k = 10; n = 2,758), duration of delirium (RR = -1.18; 95% CI = -1.95 to -0.40; I = 45%; k = 6; n = 276), severity of delirium (standard mean difference = -0.98; 95% CI = -1.46 to -0.49; I = 0%; k = 3; n = 82), and pressure ulcers (RR = 0.48; 95% CI = 0.26-0.88; I = 0%; k = 2; n = 457).
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.
全面评估多组分干预措施预防住院老年人谵妄的效果。
系统评价，采用系统评价和荟萃分析的首选报告项目方法进行荟萃分析。
所有随机对照试验均包括在内。纳入的研究对象为住院老年人（年龄≥65 岁）。
检索 MEDLINE、EMBASE、Web of Science 和 Cochrane 对照试验中心注册数据库（检索日期：2015 年至 2019 年 3 月）。使用预设标准确定纳入研究并评估其方法学质量。
从 1250 条记录中，确定了 10 项随机对照试验（n = 2850：1355 例内科患者、1243 例外科患者和 160 例重症监护病房患者）。与常规护理相比，多组分干预措施降低了谵妄的发生率（风险比（RR）= 0.62；95%置信区间（CI）= 0.54-0.72；I = 0%；k = 10；n = 2758）、谵妄持续时间（RR = -1.18；95%CI = -1.95 至-0.40；I = 45%；k = 6；n = 276）、谵妄严重程度（标准均数差=-0.98；95%CI = -1.46 至-0.49；I = 0%；k = 3；n = 82）和压疮（RR = 0.48；95%CI = 0.26-0.88；I = 0%；k = 2；n = 457）。
荟萃分析表明，多组分干预措施预防谵妄可有效降低其发生率、持续时间和严重程度；以及住院老年人压疮的发生率。因此，多组分干预措施有望对影响住院期间脆弱老年人最常见和最严重的疾病产生重大影响。
