Review articlePrevention of delirium in demented hospitalized patients
Section snippets
Methods
The aim of our study was to compare the incidence of delirium in demented non delirious patients 75 years and older hospitalised in a 26 bed acute care geriatric unit before and after the implementation of a preventive strategy improving their temporospatial orientation.
Delirium was diagnosed by the confusion assessment method (CAM) [7] and the interview of a care giver asked about any recent cognitive or comportemental change. Patients included had a diagnosis of dementia prior to admission.
Results
Out of the 367 patients admitted during the first period 123 (33.5%) had a diagnosis of dementia: 89 Alzheimer diseases, 17 dementias with Lewy bodies, 17 Alzheimer diseases with cerebrovascular lesions. 79 patients were treated. There were 86 women and 36 men, mean age of 84.6 ± 6.2 years (75–99). The mean MMSE was of 14.3 ± 7.8 (3–21). 19 of these patients became delirious (15.45%). During the second period, 133 (33.1%) out of the 372 admitted patients were demented: 92 Alzheimer diseases, 19
Discussion
To our knowledge, no previous study has evaluated the effectiveness of a preventive intervention in a demented hospitalised population. Dementia is recognized as the most important risk factor for delirium [3]. However in the major preventive studies undertaken in medical [6] and surgical wards [9], the subgroup of demented patients was a posteriori defined with conflicting results. In one study [6], the multicomponent strategy was effective in reducing the incidence of delirium by almost 50%
Learning points
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Delirium is preventable in demented hospitalized patients. Among the measures integrated into the multicomponent published preventive strategies, the orientation protocol is possibly the most important in this population and should be considered in post surgical protocol.
Conflicts of interest
The author has no financial or any other kind of personal conflicts with this paper.
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2022, NPG Neurologie - Psychiatrie - GeriatrieRecognition, prevention, and treatment of delirium in emergency department: An evidence-based narrative review
2020, American Journal of Emergency MedicineCitation Excerpt :It is more likely that a care bundle in the ED can adapt part of the six components from the HELP program, such as reducing sleep deprivation while patients are staying in the ED, correcting vision and hearing with environmental adjustment and aids, providing hydration and early mobilization. A newer meta-analysis pooling the results of non-pharmacological multicomponent prevention interventions [93,94] concluded that the number needed to treat (NNT) was 14 to prevent delirium [95]. The ABCDEF bundle was developed for mechanically ventilated patients in the ICU setting and adheres to pain, agitation, and delirium guidelines [96].
Hospital Elder Life Program: Systematic Review and Meta-analysis of Effectiveness
2018, American Journal of Geriatric PsychiatryCitation Excerpt :The present analysis systematically updates a previous meta-analysis. Delirium incidence: Twelve studies of the HELP model10,18,19,21,23–26,29,30,53,54 measured delirium incidence. In total, the meta-analysis involved 3,605 patients and showed that the odds of delirium were 53% lower in the intervention group compared with controls (OR 0.47; 95% CI 0.37–0.59, I2 = 28%).
Preventing delirium in dementia: Managing risk factors
2016, MaturitasCitation Excerpt :Few studies have specifically investigated the role of MI in people with dementia. Andro et al. [35] investigated the role of a ‘temporospatial orientation and communication program’ in patients with established dementia admitted to a 26 bed acute care geriatric unit. They compared the incidence of delirium (as diagnosed by the CAM) before and after the introduction of this program during a 6-month period.
Pilot study of a preventive multicomponent nurse intervention to reduce the incidence and severity of delirium in hospitalized older adults: MID-Nurse-P
2016, MaturitasCitation Excerpt :The most widely disseminated approach is the HELP [31], a multicomponent intervention strategy with proven effectiveness and cost-effectiveness in the prevention of delirium and functional decline [44,45]. Previous studies have included cognition/orientation therapies [11,31,33,34,39–41,43,46], hydration review [11,31,43,46], feeding/nutrition [11,31,33,34], avoidance of vision and hearing deprivation [11,31,40,43,46], early mobilization/rehabilitation [11,31,33,37,38,43], constipation prevention [43], pain assessment [43], exercise [39], staff education [11,31,37,38], family/caregiver education [40], and sleep-wake cycle preservation [11,31]. In our study we included all aforementioned interventions, plus drug chart review, urinary elimination, and oxygenation, in order to cover all possible delirium risk factors described in the literature.