Table 1 Summary of studies on delirium management in acute hospitals
From: A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit
Study | Subjects, n | Interventions | Outcomes | Results |
|---|---|---|---|---|
Cole et al, 1994 | 88 | • Geriatric consultation within 24 hours • Daily nursing visits • Nursing intervention protocol | • SPMSQ (memory, orientation, concentration) • CAM • CGBRS (behaviour and ADLs) | • Improvement in SPMSQ scores at 2 weeks but no difference at 8 weeks • No difference in restraint use, LOS, discharge setting, survival |
Cole et al, 2002 | 227 | • Geriatrician consult within 24 hours • Daily nurse visits • Nursing intervention protocol | • MMSE • Delirium Index • Barthel index • LOS • Survival within 8 weeks • Charlson's | • No difference in time to improvement • No difference in delirium index, Barthel, LOS, discharge setting, and survival. |
Flaherty et al, 2003 | 196, 69 with delirium | • 24 hour intensive nursing care • Physical restraints-free policy • Comprehensive geriatric care | • Not applicable (descriptive study) | • No physical restraints used during patient hospital stay. • Lower use of pharmacological restraints • LOS equal to expected LOS |
Lundstrom et al, 2005 | 400, 125 with delirium | • 2-day education course for staff on Geriatrics • Education for caregiver-patient interaction • Work reorganization (focus on individualized care) • Monthly staff guidance | • OBS scale • MMSE • Katz ADL • DSM IV for delirium | • Fewer patients remained delirious on day 7. • LOS lower with intervention. • Fewer deaths in subjects in intervention ward. |
Pitkala et al, 2006, 2008 | 174 | • Comprehensive geriatric assessment • Administering atypical antipsychotics instead of conventional neuroleptics • Orientation • Physiotherapy • Nutritional supplementation • Hip protectors • Cholinesterase inhibitors • Discharge planning | • Discharge destination and mortality • MMSE • Barthel • MNA • Geriatric Depression Scale • MDAS • Costs & HRQoL | • No significant difference in primary outcome (Institutionalisation and mortality) • Intensity and symptoms of delirium were alleviated faster in treatment group • Improvement in cognition at 6 months • No difference in change of function |