title: Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial.
abstract: BACKGROUND
  Delirium is a common syndrome with poor prognosis affecting elderly inpatients. Treatment is mainly based on common sense with wide variations in practice. We investigated whether intensified, multicomponent geriatric treatment could improve the prognosis of delirious patients.
  
  
  METHODS
  We performed a randomized, controlled trial of 174 patients with delirium in six general medicine units from an acute hospital in Helsinki, Finland. The intervention group received individually tailored geriatric treatment. The primary endpoint was the sum of those deceased individuals and the patients permanently institutionalized. Secondary endpoints included the number of days in hospitals and other institutions, delirium intensity, and cognition.
  
  
  RESULTS
  The mean age of patients was 83 years, and 31% had previous dementia. The intervention group (N = 87) received significantly more acetylcholinesterase inhibitors (58.6% vs 9.2%), atypical antipsychotics (69.8% vs 30.2%), specialist consultations (49.4% vs 28.7%), hip protectors (88.5% vs 3.4%), physiotherapy (87.4% vs 47.1%), and fewer conventional neuroleptics (8.0% vs 23.0%) than did the control group (N = 87). During the 1-year follow-up, 60.9% of the intervention group and 64.4% of controls were either deceased or permanently institutionalized (p =.638). The intervention group spent a mean of 126 days in institutions, and the control group 140 days (p =.688). Delirium was, however, alleviated more rapidly during hospitalization, and cognition improved significantly at 6 months in the intervention group.
  
  
  CONCLUSIONS
  Faster alleviation of delirium and improved cognition justify good, comprehensive geriatric care for these patients although treatment produced no significant improvements in hard endpoints of prognosis.
authors.affiliation: The Central Union for the Welfare of the Aged, Malmin Kauppatie 26, 00700 Helsinki, Finland. kaisu.pitkala@vanhustyonkeskusliitto.fi
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkälä
authors.forename: Jouko V
authors.initials: JV
authors.lastname: Laurila
authors.forename: Timo E
authors.initials: TE
authors.lastname: Strandberg
authors.forename: Reijo S
authors.initials: RS
authors.lastname: Tilvis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003693:Delirium / Q000628:therapy*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D026741:Physical Therapy Modalities; D012017:Referral and Consultation; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors