Beccacece Alessia, Samuelsson Olafur, Jónsdóttir Freyja, Fedecostante Massimiliano, Gudmundsson Adalsteinn, Cherubini Antonio
Geriatria Accettazione Geriatrica e Centro di ricerca per l'invecchiamento. IRCCS INRCA, Via Della Montagnola 81, 60100, Ancona, Italy.
Eir Nursing Home, Reykjavik, Iceland.
Eur Geriatr Med. 2025 Jul 10. doi: 10.1007/s41999-025-01269-x.
Delirium in nursing home (NH) residents is typically multifactorial and complex. This narrative review aims to synthesize the current literature on medications that are identified as predisposing and precipitating factors for delirium in older adults in NHs.
A comprehensive PubMed search was carried out to identify English-language publications up to March 2025. Studies were included if they explored the role of medications in inducing delirium in NH residents aged 65 years and older.
While there is substantial evidence linking medications to delirium, the number of studies evaluating their effects in the NH setting is notably limited. Several studies conducted in NHs confirmed the association between anticholinergic drugs and delirium. Antipsychotic medications and benzodiazepines may increase the risk of delirium onset. However, the studies conducted in NHs are insufficient to make definitive recommendations due to the small sample sizes and conflicting results. Other classes of medications have been recognized as potential delirium triggers in other healthcare settings, but existing evidence in NHs is either limited or absent.
Determining which medications that trigger delirium is complicated by the presence of numerous confounding factors among NH residents, including cognitive impairment, frailty, multimorbidity, polypharmacy, acute medical conditions, pain, end-of-life care, and organizational factors that can interact and amplify the risk. More research is necessary to establish the role of medications in the etiology of delirium in this population.
疗养院（NH）居民的谵妄通常是多因素且复杂的。本叙述性综述旨在综合当前有关被确定为NH中老年人谵妄的诱发和促发因素的药物的文献。
进行了全面的PubMed搜索，以识别截至2025年3月的英文出版物。如果研究探讨了药物在诱导65岁及以上NH居民谵妄中的作用，则纳入研究。
虽然有大量证据将药物与谵妄联系起来，但评估其在NH环境中作用的研究数量明显有限。在NH中进行的几项研究证实了抗胆碱能药物与谵妄之间的关联。抗精神病药物和苯二氮䓬类药物可能会增加谵妄发作的风险。然而，由于样本量小和结果相互矛盾，在NH中进行的研究不足以提出明确的建议。其他类别的药物在其他医疗环境中已被认为是潜在的谵妄触发因素，但NH中的现有证据要么有限，要么不存在。
由于NH居民中存在众多混杂因素，包括认知障碍、虚弱、多种疾病、多重用药、急性医疗状况、疼痛、临终关怀以及可能相互作用并放大风险的组织因素，确定哪些药物引发谵妄很复杂。需要更多的研究来确定药物在该人群谵妄病因中的作用。
