title: Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis.
abstract: OBJECTIVE
  Delirium, an acute disorder with high morbidity and mortality, is often preventable through multicomponent nonpharmacological strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies to date.
  
  
  OBJECTIVE
  To evaluate available evidence on multicomponent nonpharmacological delirium interventions in reducing incident delirium and preventing poor outcomes associated with delirium.
  
  
  METHODS
  PubMed, Google Scholar, ScienceDirect, and the Cochrane Database of Systematic Reviews from January 1, 1999, to December 31, 2013.
  
  
  METHODS
  Studies examining the following outcomes were included: delirium incidence, falls, length of stay, rate of discharge to a long-term care institution (institutionalization), and change in functional or cognitive status.
  
  
  METHODS
  Two experienced physician reviewers independently and blindly abstracted data on outcome measures using a standardized approach. The reviewers conducted quality ratings based on the Cochrane risk-of-bias criteria for each study.
  
  
  METHODS
  We identified 14 interventional studies. The results for outcomes of delirium incidence, falls, length of stay, and institutionalization were pooled for the meta-analysis, but heterogeneity limited our meta-analysis of the results for change in functional or cognitive status. Overall, 11 studies demonstrated significant reductions in delirium incidence (odds ratio [OR], 0.47; 95% CI, 0.38-0.58). Four randomized or matched trials reduced delirium incidence by 44% (OR, 0.56; 95% CI, 0.42-0.76). The rate of falls decreased significantly among intervention patients in 4 studies (OR, 0.38; 95% CI, 0.25-0.60); in 2 randomized or matched trials, the rate of falls was reduced by 64% (OR, 0.36; 95% CI, 0.22-0.61). Length of stay and institutionalization also trended toward decreases in the intervention groups, with a mean difference of -0.16 (95% CI, -0.97 to 0.64) day shorter and the odds of institutionalization 5% lower (OR, 0.95; 95% CI, 0.71-1.26). Among higher-quality randomized or matched trials, length of stay trended -0.33 (95% CI, -1.38 to 0.72) day shorter, and the odds of institutionalization trended 6% lower (OR, 0.94; 95% CI, 0.69-1.30).
  
  
  CONCLUSIONS
  Multicomponent nonpharmacological delirium prevention interventions are effective in reducing delirium incidence and preventing falls, with a trend toward decreasing length of stay and avoiding institutionalization. Given the current focus on prevention of hospital-based complications and improved cost-effectiveness of care, this meta-analysis supports the use of these interventions to advance acute care for older persons.
authors: Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts2Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors: Tammy T
authors: TT
authors: Hshieh
authors: Department of Geriatrics, West China Hospital, Sichuan University, Chengdu.
authors: Jirong
authors: J
authors: Yue
authors: Division of Geriatric Medicine and Gerontology, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Esther
authors: E
authors: Oh
authors: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors: Margaret
authors: M
authors: Puelle
authors: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors: Sarah
authors: S
authors: Dowal
authors: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts5Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors: Thomas
authors: T
authors: Travison
authors: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts5Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors: Sharon K
authors: SK
authors: Inouye
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D003221:Confusion / Q000209:etiology; D003693:Delirium / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007326:Institutionalization / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D015588:Observer Variation; D016017:Odds Ratio; D011788:Quality of Life; D012107:Research Design; D016896:Treatment Outcome
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