Chong et al., 20142121 Chong MS, Chan M, Tay L, Ding YY. Outcomes of an innovative model of acute delirium care:the Geriatric Monitoring Unit (GMU). Clin Interv Aging 2014;9:603-12.
|
• NP |
• 320 geriatric patients (IW 234/ CW 39/ HCW 47), 84 years, 39% |
• I: HELP program, bright light therapy (2,000-3,000 lux 6-10 pm) |
• No impact on delirium duration, length of stay, nosocomial infection, mortality or discharge destination • Improvement in functional status (MBI 19.2 vs 15.2 vs 7.5, p<0.05), restraint rate (0 vs 23.1 vs 44.7%, p<0.05), and pressure ulcer (4.1 vs 1.3 vs 9.1% p<0.05) |
• Small control group; dementia IW>CW. • Statistical differences among the three groups (IW, CW and HCW, respectively) |
Cole et al., 19942222 Cole MG, Primeau FJ, Bailey RF, Bonnycastle MJ, Masciarelli F, Engelsman F, et al. Systematic intervention for elderly inpatients with delirium: A randomized trial. CMAJ 1994;151(7):965-70.
|
• NP |
• 88 clinical patients (IW 42/ CW 46), 86.1 years, 35% |
• I: psychiatric and geriatric specialist, EI, OI, FI,CI, early mobility |
• No impact on restraint rate, length of stay, mortality, discharge dependence, and cognitive decline in 8 weeks. • Improvement in cognitive decline in 2 weeks (SPMSQ, p<0.05) |
• Small sample, very ill patients, high mortality rate (35%) sub diagnosis of delirium
|
Cole et al., 20022323 Cole MG, McCusker J, Bellavance F, Primeau FJ, Bailey RF, Bonnycastle MJ, et al. Systematic detection and multidisciplinary care of delirium in older medical inpatients:a randomized trial. CMAJ 2002;167(7):753-9.
|
• NP |
• 227 clinical patients (IW 113/ CW 114), 82 years, 46% |
• I: psychiatric and geriatric specialist, EI, OI, FI, CI, early mobility |
• No impact on cognitive decline in 8 weeks, delirium severity, functional status, length of stay, discharge rate, and mortality |
• Same staff care between IW and CW |
Hu et al., 20062424 Hu H, Deng W, Yang H, Liu Y. Olanzapine and haloperidol for senile delirium: A randomized controlled observation. Chinese Journal of Clinical Rehabilitation 2006;10(42):188-90.
|
• P |
• 175 university hospital patients (IP1 72/IP2 74/ CP 29), 73.8 years, 63% |
• I1: haloperidol 2.5-10mg IM per day; I2: olanzapine 1.25-20 mg per day PO or SL; C: no drug for CNS |
• Improvement in severity of mental illness in 7 days (I1>I2>C, p<0.01), global recovery of mental disease in 7 days (I1>C,p<0.01), DRS in 1 day (I2<I1<C,p<0.01), DRS in 7 days (I1<C,p<0.01) |
• Non intention-to-treat protocol |
Litvinenko et al., 20102525 Litvinenko IV, Odinak MM, Khlystov IuV, Perstnev SV, Fedorov BB. Efficacy and safety of rivastigmine (exelon) in the confusion syndrome in the acute phase of ischemic stroke. Zh Nevrol Psikhiatr Im S S Korsakova 2010;110(11 Pt2):36-41.
|
• P |
• 68 ischemic stroke patients (IP 21/ CP 47), IG, IG |
• I: rivastigmine 9-12mg PO per day for 14-25 days followed by patch of 9.5 mg per day for 8 months; C: haloperidol as needed |
• Improvement in delirium duration 3 -12 days vs 5 – 28 days, p<0.001), FAB (14,8 vs 12, p< 0.001), MMSE (26.7 vs 22.5 p<0.001), 10-word memorizing test (3.5 vs 2.4, p<0.05), and caregiver burden in 3 and 6 months (p<0.05) |
• Open label study, lethality I=22.8%, C=36.2% not compared; dementia prevalence ignored |
Marcantonio et al., 20102626 Marcantonio ER, Bergmann MA, Kiely DK, Orav EJ, Jones RN. Randomized trial of a delirium abatement program for postacute skilled nursing facilities. J Am Geriatr Soc 2010;58(6):1019-26.
|
• NP |
• 457 clinical or surgical patients (IW 282/ CW 175), 84 years, 35% |
• I: systematic assessment of delirium causes; OI; EI; CI; PC; UF; caregiver guide |
• No impact on delirium persistence or mortality |
• Incentive payment for delirium diagnosis in IW |
Mudge et al., 20132727 Mudge AM, Maussen C, Duncan J, Denaro CP. Improving quality of delirium care in a general medical service with established interdisciplinary care:a controlled trial. Intern Med J 2013;43(3):270-7.
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• NP |
• 46 clinical patients (IW 19/ CW 27), 83.1 years, IG |
• I: staff education and training; judicious use of drugs for CNS; hydration; EI; OI; CI;FI; PC; UF; caregiver guide; catheter control; staff and caregiver guide |
• No impact on mortality and falls. IW more likely to receive psychogeriatric consultation (32% vs 11%, p = 0.04), and with a longer length of acute stay (median IQR: 16 vs 8 days, p<0.01) |
• Daily evaluation of delirium was not done, implementation of interdisciplinary team care in both wards |
Niu et al., 20142828 Niu W-B, Li Z-Y, Zhang X-N, Zhang J, Wang G-Y, Yu Y-M. Postoperative delirium in elderly patients with colorectal cancer:Risk factors and treatment. World Chinese Journal of Digestology 2014;22(34):5381-4.
|
• P |
• 18 postoperative patients (IP 9/ CP 9), 79.5 years, IG |
• I: droperidol 5mg IM; C: no drug for CNS |
• Improvement in length of hospital stay (p<18.3 vs 21.1 days, p<0.05); delirium remission (6 vs 1 patient, p<0.05) |
• Small sample; dementia prevalence ignored |
Overshott et al., 20102929 Overshott R, Vernon M, Morris J, Burns A. Rivastigmine in the treatment of delirium in older people:a pilot study. Int Psychogeriatr 2010; 22(5):812-8.
|
• P |
• 15 clinical patients (IP 8/ CP 7), 83 years, 53.3% |
• I: rivastigmine 1.5-3.0 PO per day; C: placebo |
• Improvement in delirium remission rate in 28 days (8 vs 3 patients, p=0.03) • No impact on delirium duration |
• Small sample; low rivastigmine dose; CAM obtained from ward nurse |
Pitkälä et al., 20063030 Pitkala KH, Laurila JV, Strandberg TE, Tilvis RS. Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2006;61(2):176-81.
|
• P/NP |
• 174 clinical and surgical patients (IP 87/ CP 87), 83.6 years, 26% |
• I: preference for atypical antipsychotics as needed; OI; FI; physiotherapy; calcium and vitamin D supplements; hip protectors; nutritional supplements; cholinesterase inhibitors as needed; geriatric specialist; C: conventional neuroleptics as needed |
• Decrease in time to delirium recovery (sustained improvement of at least 4 points on MDAS) (p<0.002); improvement on MMSE in 6 months (18.4 vs 15.8, p=0.047). Higher number of days in acute care (52 vs 42, p=0.032) • No impact on functional status or combined endpoint (permanent institutional care or death in 3 and 6 months) |
• Very frail patients; implementation of interdisciplinary team care in both groups |