Multicomponent Interventions for the Prevention of Delirium in Hospitalized Older People: A Meta‐Analysis
Beatriz León‐Salas, María M. Trujillo‐Martín, Luis Pedro Martı́nez del Castillo, Javier García‐García, Pilar Pérez‐Ros, Francisco Rivas‐Ruiz, Pedro Serrano‐Aguilar
Abstract
OBJECTIVES To comprehensively assess the effects of multicomponent interventions for prevention of delirium in hospitalized older people. DESIGN Systematic review with meta‐analysis following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses methods. PARTICIPANTS All randomized controlled trials were included. Included studies were conducted in hospitalized older people (aged ≥65 years). MEASUREMENTS 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. RESULTS 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 2 = 0%; k = 10; n = 2,758), duration of delirium (RR = −1.18; 95% CI = −1.95 to −0.40; I 2 = 45%; k = 6; n = 276), severity of delirium (standard mean difference = −0.98; 95% CI = −1.46 to −0.49; I 2 = 0%; k = 3; n = 82), and pressure ulcers (RR = 0.48; 95% CI = 0.26–0.88; I 2 = 0%; k = 2; n = 457). CONCLUSIONS 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.